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Humana
Overview
Conduct comprehensive clinical reviews of prior authorization requests for behavioral health services to determine medical necessity and benefit eligibility. Coordinate with healthcare providers and medical directors while documenting findings in clinical systems to ensure regulatory compliance.
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Compensation
Salary not listed
Posted
14 days ago
Capital Health (US)
Performs clinical chart reviews to determine the appropriateness of patient care levels and ensures compliance with regulatory guidelines. Collaborates with medical staff and payers to manage patient progression, reduce length of stay, and optimize resource utilization.
$39 - $51 / HOUR
1 month ago
UnitedHealth Group
The role involves implementing daily telephonic case management interventions for high-risk members by assessing needs and coordinating discharge plans with clinical teams while following members in the acute inpatient setting. Key duties include evaluating discharge needs, coordinating post-discharge care with providers, participating in rounds, and arranging necessary post-hospital services.
$60,200 - $107,400 / YEAR
3 months ago
