Assesses member needs and identifies solutions that promote high quality and cost-effective health care services. Manages requests for services from providers, members, and care management team and renders clinical determinations in accordance with VNS Health Plans policies as well as applicable state and federal regulations. Delivers timely notification detailing VNS Health clinical decisions. Coordinates with VNS Health Plans team, subject matter experts, physicians, member representatives, and discharge planners to ensure care is appropriate, timely and cost effective. Works under general supervision.
$85,000.00 - $106,300.00 Annual
What We Provide