Applies a multidisciplinary approach to organize, coordinate, monitor, evaluate and modify plans of care and/or service requests, focusing on selected complex medical and psychosocial needs of members and their families. Assures the coordination of evidence-based, cost efficient medical outcomes for the member and organization. Collaborates to perform first level reviews to authorize services, procedures and tests in accordance with CHP benefit criteria, applicable regulatory review criteria and nationally accepted criteria for medical necessity and benefit determinations.
Licensed Nurse in the State of Florida. Skilled in the use of MS office software. Must occasionally lift and/or move up to 10 pounds. Able to work evenings, weekends and holidays as directed, and to travel locally.
Bonus eligible. Associated topics: lead, licensed practical, licensed practical nurse, med, mtp, nurse i, nurse iii, nurse iv, nurses, practical nurse
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.