Pre-screens all potential enrollee’s eligibility for MLTC services and ensures all pre-enrollment criteria are met prior to scheduling visit. Collaborates with Medicaid Specialist as needed to assist with consumer’s Medicaid eligibility.
The Care Management Reassessment RN Supervisor will be responsible for providing clinical supervision to all Care Management Reassessment RN’s (CM RA RN’s) as well as ensuring that Reassessment Coordinators and others that support Care Management Reassessment RN’s activities receive guidance and support.
RN Care Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate long-term care services for Extended MLTC members through assessment and member-centered care planning, direct provider coordination and collaboration to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes.
Representative will be responsible for assisting in service claim review and other data analysis, assisting with provider claim inquiries/appeals, and supporting the department as needed.
RN Care Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate long-term care services for Extended MLTC members through assessment and member-centered care planning, direct provider coordination and collaboration to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes.
Representative will be responsible for ensuring excellent and efficient customer service, ensuring that all covered services are authorized and placed in a timely manner, as well as provide support for all functions of the Extended MLTC as required.
The Utilization Nurse will be responsible for reviewing authorization requests/claims for medical necessity, under the direction and supervision of the Director of UM/Transitional Service Dept.
