| Assesses and evaluates clinical and financial information available and recommends the most appropriate setting for service delivery, including level of care in order to optimize resource consumption and reimbursement.|
Precertifies patient care services that require precertification, as identified, in a timely, efficient manner, in order to optimize reimbursement for the patient, as well as health care providers.
Communicates recommendations, clinical information, and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction.
Participates in the planning, data collection, and analysis phases of performance improvement activities in order to maximize the patient placement/precertification process.
Completes assigned goals.
|Recommends the most efficient, cost effective utilization of resources within the continuum of care, prior to the delivery of services. Evaluates, assesses, plans and facilitates a plan of care. Precertifies inpatient and outpatient services. Some overtime and call back is required. This position is under the general direction of the Director for Medical Review Services/Case Management. Performs other duties as assigned.|
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| || LPN with three (3) years of acute care experience; or an individual with 5 years of utilization management/case management experience.|| Prefer additional two years of quality/utilization management or dischage planning experience.|
| || || LPN|