Head of Case Management: Directs, coordinates, and oversees case management to assure quality cost effectiveness of high risk and high cost cases. Develops guidelines for working with patients, health care management companies, insurance companies or other third party payers to determine quality cost effective care.
Evaluates outcome of patient care. May include prospective and retrospective review that includes, but is not limited to, prior authorization, determining the appropriate level of care and utilization of services, concurrent review, retrospective review, developing discharge plans, and ensuring quality cost effectiveness. May arrange referrals, consultations, therapeutic services, and confer with other specialists on course of care and treatment. (Source: eDOT Job Description) [-] Less
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