Utilization Management Case Manager PD

Job description

Responsible for the utilization management, quality assurance, and discharge planning activities for assigned services/areas/patients within Cottage Health. Case management activities will result in quality outcomes, optimal care/cost management of services and/or procedures, a high level of customer satisfaction and contribution to an overall value-oriented experience of stakeholders and persons served. This is not an exhaustive statement of duties, responsibilities, or requirements. Employees will be required to perform any job, with related instruction given by their supervisor, subject to reasonable accommodation. All job qualifications listed indicate the minimum level necessary to perform this job proficiently. - Resource Management: Understand the principles of reimbursement and the services within the reimbursement parameters. Ascertain healthcare benefits utilizing both internal and external resources as appropriate to coordinate necessary and appropriate care, while appropriately preserving the healthcare benefits of the beneficiary. Identify and refer situations requiring immediate intervention to the attending physician, risk management, department director and/or physi...