About the job
General Summary Of Position
Provides support for the Care Management Department by coordinating and promoting comprehensive quality cost-effective care.
_1-2 years Utilization review experience required_
- This role requires you to be on-site in Washington, DC, four days per week, with one remote workday each week.*
Key Responsibilities
- Assists in the identification of potential Case Management candidates through clinical review, selected diagnoses, etc., and makes appropriate referrals.
- Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
- Demonstrates behavior consistent with MedStar Health mission, vision, goals, objectives and patient care philosophy.
- Identifies and reports potential coordination of benefits, subrogation, third party liability, workers compensation cases, etc. Identifies quality, risk, or utilization issues to appropriate MedStar personnel.
- Initiates contact with providers to obtain clinical information to facilitate care or pending pre-certification requests. Interacts with assigned disease management populations of limited volume. Interaction is designed to improve patient access to care, and education regarding the disease and support services.
- Maintains current knowledge of MedStar Family Choice benefits and enrollment issues in order to accurately coordinate services.
- Maintains expertise in general benefit management and serves as a resource for MedStar Family Choice members, physicians, and staff for benefit interpretation and coordination.
- Maintains timely and accurate documentation in the IS System per Case Management policy.
- Participates in meetings, work groups, etc. as assigned.
- Processes pre-authorizations for medical necessity, LOC, covered benefits, and participation of the provider at the discretion of the guidelines and Medical Reviewer.
- Sends reviews to Medical Reviewer as appropriate. Coordinates review decisions and notifications, per policy.
What We Offer
- Culture- Collaborative, inclusive, diverse, and supportive work environment.
- Career growth- Career mentoring to help you pursue your passions and gain skills to enhance your value.
- Wellbeing- Competitive salary and Total Rewards benefits to help keep you happy and healthy.
- Reputation- Regional & National recognition, advanced technology, and leading medical innovations.
Qualifications
- 1-2 years Utilization review experience required.
- 3-4 years Diverse clinical experience required.
- Active DC LPN License required.
This position has a hiring range of $60,632 – $107,494