- Position Summary: The general purpose of this position is to effectively and efficiently screen and enter referrals for capitated patients. Performs admission reviews, discharge planning, case management, and Primary Care Physician (PCP) communication.
Required: Bachelors Degree
Required: 10+ years of previous job-related experience
Required: Current Registered Nurse License State of Illinois
Preferred: Current Registered Nurse License State of Illinois
Position Responsibilities: REFERRAL MANAGEMENT - Screens all HMO referrals at LUMC for capitated patients. INPATIENT ADMISSION REVIEW - Reviews all inpatient admissions. PHYSICIAN, PRIMARY CARE STAFF & PATIENT COMMUNICATION - Serves as a resource and liaison for patients by answering questions about managed care, Medicaid programs, benefits and resources. DISCHARNGE PLANNING - Anticipates and facilitates patient discharge plans to ensure a smooth transition to the next level of care. Responsible for case management of patients with chronic medical problems or patients requiring additional intervention to successfully manage their disease process. Works closely with Primary Care clinical site on the referral process. Issue denial letters to member on non-covered services in accordance with the scope of benefits. Answers telephone calls from various clincs as well as outside proivders to confirm referral status.