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.
Coordinator will be responsible for assisting in the transitional process to accommodate an efficient and timely start of care for perspective enrollees through the said responsibilities below. The Transitional Liaison Coordinator will receive and get guidance from the Transitional Team Leader.
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.
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.
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 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.
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.
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.
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.
