Effectively and efficiently manage the hospital case management process and facilitate the communication process between all role players by providing accurate and timely clinical information to minimize the financial risk for the organization

KEY RESPONSIBILITY AREAS

• Effective coordination of patient care plans to minimize financial risk for the company
• Effectively manage the quality of clinical documentation
• Provide clinical expertise for managing insurance claims with the supportive medical justifications based on good clinical practice
• Focus on continuous quality improvement of clinical documentation
• Conduct concurrent and retrospective utilization reviews to ensure medical necessity, appropriate level of care, and compliance with payer requirements.
• Monitor Length of Stay (LOS) and facilitate timely discharge planning
• Coordinate with treating physicians and insurance teams to obtain timely ap...