Case Management Coordinator

Job Description: In the UM department, Case Management Coordinator is to assist with the coordinating of the day-to day activities in the medical group, request for authorization for ancillary services, and certify the group is utilizing the most cost effective provider. Also, identify patients found in out-of-network facilities and send the information timely to the concurrent-review nurse for coordination with the hospital and group. Responsibilities include, but not limited to: Case management following Policy and Procedures (P&P) Assure authorization is on file for all services approved by the delegated entity prior to claims payment Notify the CM nurse if patients are out-of-network Coordinate and request authorizations with IPA Enter and process authorization requests File and process medical records Establish and maintain authorization files, project files and other highly confidential information Screen telephone calls and handle appropriately Prepare package and data for Joint...