that affect member eligibility. Coordinates with other departments, e.g. Care Management, Legal Affairs, Grievance and Appeals... clinical, environmental, and social to establish an individual plan of care needed to maintain the member safe in the community...
that affect member eligibility. Coordinates with other departments, e.g. Care Management, Legal Affairs, Grievance and Appeals... clinical, environmental, and social to establish an individual plan of care needed to maintain the member safe in the community...
Summary of Position Direct supervision of the Clinical Nurse Reviewer staff, oversee the clinical team... and operational functions related to the review of clinical records and service appeals for purposes of providing clinical summaries...
Affairs, Grievance and Appeals, Compliance, Membership Eligibility Unit, Quality as needed. Participates in requests for out... clinical, environmental, and social to establish an individual plan of care needed to maintain the member safe in the community...