The Care Manager is a Registered Nurse with experience and background to conduct medical necessity reviews, coordinate care management, and assess for the transition of care of the patient. The primary goal is to ensure the accuracy of on-going patient status documented to support the level of care being provided and services rendered. She or he acts as a resource to the nursing and medical staff providing clinical expertise in the areas of utilization review, status determination, discharge planning, and community resources. Knowledge and experience in working with specific patient populations, i.e., children, elderly, and knowledge of Federal and State regulatory agency requirements.
In addition, knowledge of Milliman Care Guidelines is required and experience with on-line Milliman Care Guidelines is highly desired. Must have a minimum of two years acute care case management experience.
Healthcare News - 13 months ago