Job Title: Managed Care Coordinator UM II Position Summary: The Managed Care Coordinator UM II reviews and evaluates... compliance with ERISA, NCQA, URAC, DOI (State), DOL (Federal). Care & Discharge Planning (25%) Assess service needs...
(Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data... health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site...
guidelines. Identify and make referrals to appropriate staff such as Medical Directors, Case Managers, and Quality of Care... medical necessity criteria and contract benefits. Collaborate with BCBSSC Care Management and other areas to ensure proper...
Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participate in data collection...), and DOL (Federal). Participate in direct intervention/patient education with members and providers regarding the health care...
in nursing care. The 607-bed teaching hospital anchors a health care network that includes six community medical centers... and employs more than 8,700 health care professionals. The network includes a cardiovascular program recognized by the American...
in nursing care. The 607-bed teaching hospital anchors a health care network that includes six community medical centers... and employs more than 8,700 health care professionals. The network includes a cardiovascular program recognized by the American...