Job SummaryPerforms and ensures adherence to state, federal and third party payer certification requirements for initial, concurrent and retrospective medical record review for medical necessity and level of care determination.Job DutiesIdentifies and notifies appropriate staff regarding discrepancy issues with third party payer health insurance coverage and lack of coverage.Maintains a working knowledge of third party payer health plans, working knowledge of nationally recognized review criteria and its application and state and federal regulations and mandates.Reviews cases, using standard parameters, in order to perform precertification requirements as indicated in third party payer contracts.Reviews all admission requests for app
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Case Management Society of America 5034A Thoroughbred Lane Brentwood, TN 37027