License Practical Nurse

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

Duties:

Complete face to face visits with members in case management and as directed by the case manager. This role requires driving to multiple locations in a given day and will cover multiple counties. Case Manager will provide the series of questions that need to be asked. The goal is to educate members on their benefits and advise them on how they are utilize them to their fullest potential. Hands off care, more observing and documenting through computer. Candidate must be a self-starter.