· The incumbent must possess medical management/clinical decision-making skills and sound skills in assessing, planning and managing member care.
· Advanced assessment and teaching skills.
· Problem solving skills.
· Familiarity with legal terminology and liability issues and ability to handle ethical or risk management issues.
· Utilization and Quality Management/Outcomes experience preferred.
· Previous work experience with a managed care organization or provider is also preferred.
· Prior experience in case management, home health, discharge planning, or Concurrent review.