Assess patients' clinical needs against established guidelines to ensure appropriate care levels
Evaluate the necessity and efficiency of medical services and coordinate care plans for members
Monitor and advocate for patients' medical care activities and outcomes across various service sites
Required Qualifications
Active NJ or Compact State Nurse License
Proficiency in personal computers and software in a Windows environment, including MS Office
Knowledge of hospital structures, payment systems, and care management principles
Understanding of health care contracts and benefit eligibility requirements
Experience in mentoring and operations of utilization/case/disease management
Average salary estimate
$70000
/ YEARLY (est.)
min
max
$60000K
$80000K
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