Perform utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management). Determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Assess and interpret customer needs and requirements. Identify solutions to non-standard requests and problems. Work with minimal guidance; seeks guidance on only the most complex tasks. Translate concepts into practice. Provide explanations and information to others on difficult issues. Coach, provide feedback, and guide others. Act as a resource for others with less experience. Required Qualifications:
Unrestricted RN license in state of Residence. 3+ years of Managed Care and / or Clinical experience. Ability to create, edit, save and send documents utilizing Microsoft Word. Ability to navigate a Windows environment. Pre-authorization experience. Utilization Management experience. Preferred Qualifications:
Case Management experience. Knowledge of MCG. Undergraduate degree in Nursing. Job Type: Full-time
Utilization Review: 2 years Nursing: 3 years Managed Care/Clinical: 3 years Required licenses or certifications:
MedWatch is a full-spectrum care management company providing clinical risk management solutions to the self-funded health plan market since 1988. Our programs are built on the philosophy that assertive, professional and personalized healthcare management should meet the clinical needs of clients and their employees while also performing cost containment support of the plan.
MedWatch proudly ma...intains triple URAC accreditation, further demonstrating our commitment to quality health care; MedWatch current accreditations: MedWatch
•Health Utilization Management since 1997
•Case Management since 2000
•Disease Management since 2007
MedWatch staff is made up of health care professionals well acquainted with the US health care delivery system and the special needs of health care recipients. Our nursing team has expertise in all levels of care, including the most acute/catastrophic and is backed up by solid MD support.
Integration of all clinical management services has continually been a focal point in the evolution of the MedWatch’s offerings; full service medical management solutions will maximize benefits for patients as well as protect plans and employers. The ability to provide early identification and stratification of patients, aggressive Case Management, Disease Management and education, and meaningful reporting of outcomes results in augmented opportunities for intervention and cost containment.
IT Infrastructure development has been a large focus of MedWatch resources. Building IT infrastructure to support timely and comprehensive communication will continue to be a primary focus for all clients and fiduciaries. MedWeb™ - our proprietary management system – provides a truly unique platform with which to manage patients throughout the continuum of care. Our web portal further enables timely and direct access to current clinical status of your members and establishes a direct link with MedWatch nurses.
MedWatch…your partner in CARE MANAGEMENT. Care Management efforts must take into consideration multiple major market pressures; national reform, unregulated and increasing provider costs, fully insured markets, cost shifting to commercial plans, stop-loss and reinsurance challenges, to name a few.
Now, more than ever, it is crucial that all players in this market join forces to mitigate risk and manage costs while maintaining the highest level of client and patient satisfaction.