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This position is fast paced telephonic position.
Requires attention to detail; understanding of clinical information.
Daily work includes phones, fax and computer skills throughout the day.
Must be a self-starter and able to problem solve basic computer issues.
Positions in this function require various nurse
licensure and certification based on role and grade level. Licensure
includes RN or LPN/LVN, depending on grade level, with current
unrestricted licensure in applicable state. LPN/LVN roles work under the
direct supervision of an RN or MD. Function is responsible for Utilization Management
which includes Concurrent Review (on-site or telephonic Inpatient Care
Management). Performs reviews of current inpatient services. Determines
medical appropriateness of inpatient and outpatient services following
evaluation of medical guidelines and benefit determination. Employees in
jobs labeled with SCA must support a government Service Contract Act