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Case Manager

As a Case Manager, you will serve as a vital link between various clinical specialties and physicians, facilitating seamless communication across the healthcare spectrum. Your role will involve engaging with insurance providers, patients, families, legal representatives, and professionals from other medical institutions. You will also collaborate closely with nursing staff, billing teams, medical social workers, and personnel from diverse departments to ensure comprehensive care and support for patients.

KEY RESPONSIBILITIES

  • Conducts comprehensive case management, includes obtaining prior authorization for medications and procedures in accordance with hospital policies and procedures.
  • Promotes, coordinates, and oversees all activities related to case management, ensuring timely and effective care delivery.
  • Safeguards patient confidentiality and handles all information in strict compliance with HIPAA regulations.
  • Executes tasks related to authorizations for outpatient services, responds to denial letters, and manages related activities efficiently.

QUALIFICATIONS

  • Bachelor’s degree in Nursing
  • Registered Nurse with a valid license from PRC
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