Job SummaryAssures appropriate level of care for preplanned admissions and observation status. Coordinates readmission review. Conducts Inpatient and Outpatient post service reviews and determines coverage based on medical necessity. Applies applicable provider penalties. Assures ongoing review of readmissions and delays in care to assure provider monitoring and/or penalties.Job DutiesServes as primary auditor of all written denial notifications prior to mailing to assure compliance with all regulatory time frames for verbal and written notification.Serves as primary support to staff to provide guidance, education and assistance with decision making and documentation processes.Works with staff and management team to support recommendations fo
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Case Management Society of America 5034A Thoroughbred Lane Brentwood, TN 37027