Responsibilities: Review UM pre-certs, continued stay and retro review requests according to evidence based criteria. Completes case management of members of assigned companies as needed, based on diagnosis, chronic care and high dollar medical or pharmacy costs. |
Must haves: BLS-OH, KY, or IN valid RN licensure. 2 yrs of UM/CM experience. |
Plusses: ACLS, EPIC experience, Leadership Experience |