***Note*** The hours for this position will be until 5pm or 5:30pm Pacific time which is 7-7:30pm Central time and 8-8:30pm Eastern time
Responsible for performing Worker’s Compensation utilization review which includes prospective, concurrent, expedited and retrospective reviews to determine medical necessity and appropriateness for requested medical care using evidence based criteria. Through the discharge planning process, identify patients who have ongoing case management needs and refer these members to the Case Management team for outreach and follow up.
Essential Duties and Responsibilities:
Additional Functions and Responsibilities
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.