Case Manager

Critical Tasks and Expected Contributions/Results:

• Manage the pre-authorisation process and claims by assessing proposed treatment and therapies for medical necessity, appropriateness and cost-effectiveness in accordance with relevant guidelines.

• Able to source and articulate said relevant guidelines while managing moderately-complex local to global level cases.

• Completes day-to-day Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members.

• Use clinical knowledge to assess diagnosis and treatment plans and goals, and identifies gaps in care or risks for readmission or complications.

• Establish patient centric goals and interventions to meet the member’s needs.

• Coordinate care and interface with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.

• Establish a documente...