Sign in

RN

Company:
W3R
Location:
Austin, Texas, 78727, United States
Salary:
37
Posted:
December 08, 2016
Description:

Makes outbound calls to the provider as required to gather additional information that may be needed.

Utilizes client specific criteria sets, applicable client specific medical policy and client clinical guidelines for decision making to either approve or summarize and route to the clients nursing reviewer and/or clients’ medical staff for review.

Conducts any utilization or medical management review activities which require the review of clinical information against client specific criteria as noted above, but excludes denial determinations.

Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract.