Job Details
Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (Inter. Qual criteria) Discuss cases with facility healthcare professionals to obtain plans-of-care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners Apply clinical expertise when discussing case with internal and external Case Managers and Physicians Identify delays in care or services and manage with MD Follow all Standard Operating Procedures in end to end management of cases Facilitate timely and appropriate care and effective discharge planning Participate in team meetings, education, discussions, and related activities Maintain compliance with Federal, State and accreditation organizations Ident...Patient Care, Management, Nurse, Medical Director, Clinical, Patient, Healthcare