Job Description
Case Management Specialist
Case Management Utilization Review Specialist manages high-cost cases ensuring departmental goals are met, timelines are adhered to, and all compliance measures are taken care of. This report directly reports to Assistant Manager – Case Managent Utilisation Review.
What you do
- Liaise with the Case Management team to develop and implement case management protocols, as well as provide training for the team.
- Identifying and reporting clinical cost drivers to plan Field Control Officers or File Reviews.
- Managing high risk and long stay cases.
- Evaluating Provider & Clinician Abuse to red flag the team . Create a framework for cost controls.
- Coordinating with BD Team & Payers to manage the expectations from Case Management perspective
- Auditing & Signing off the monthly case Management Savings report & sharing with the Assistant Manger.