What are the responsibilities and job description for the Social Work Case Manager position at Select Source International?
Job Description
Job Description
Below Job Details :
Job Title : Episodic Care Manager
Location : Remote
Duration : 12 Months (with possible extension)
Clinical Evaluation and Review
Clinical Evaluation and Review
- Receive assigned cases for varied member services (i.e. inpatient, outpatient, DME )
- Review and evaluate cases for medical necessity against medical policy, benefits and / or care guidelines and regulations .
- Complete work in accordance with timeliness, production, clinical quality / accuracy and compliance standards
- Provide notifications to member and / or provider, according to regulatory requirements.
- Assess appropriateness for secondary case review by the Medical Director (MD) for denials and coordinate as needed.
- May coordinate peer-to-peer review upon provider request when members’ health conditions do not meet guidelines
Collaboration and Documentation
Hiring Requirements
Company Description
Select Source International (SSI) is an IT, Health Care, and Engineering Services consulting firm that has been in business since 1998. SSI consultants have provided exceptional services that have been appreciated by clients, customers, and users alike at several large Fortune 500 companies, mid-size enterprises, and consulting companies.
Company Description
Select Source International (SSI) is an IT, Health Care, and Engineering Services consulting firm that has been in business since 1998. SSI consultants have provided exceptional services that have been appreciated by clients, customers, and users alike at several large Fortune 500 companies, mid-size enterprises, and consulting companies.
