SUMMARY

Responsible for assuring the receipt of high quality, cost efficient medical outcomes for those enrollees identified as having the need for inpatient/outpatient precertification.

 

ESSENTIAL DUTIES & RESPONSIBILITIES Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. Review clinical information for concurrent reviews. As part of the UMRN program, conduct ongoing availability, monitoring and oversight of non-clinical staff activities. Establish effective rapport with other employees, professional support service staff, customers, clients, patients, families, and physicians. Employ effective use of knowledge, critical thinking, and skills to: Advocate quality care and enhanced quality of life. Prevent patient complications during hospital stay. Advocate decreased hospital stay when appropriate. Maintain accurate records of all patient related interactions. Maintain regular and punctual attendance. Perform other duties as assigned.

 

SUPERVISORY RESPONSIBILITIES

None