· Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues
· Determines medical necessity/ appropriateness Facilitates optimal outcomes Identifies and follow through with continuous quality/ compliance opportunities .
May also include identification of aberrance's and initiation of corrective action Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy Optimize total costs Implementation and evaluation of policy based on usage and program directives Educate/empower colleagues at all levels to enable decision making at most appropriate level
· Client Caremark Requirements
· Prior Client/Aetna work experience: No
· Verifyable High School Diploma or GED Required: Yes
· Minimum 3 years of relevant experience
RN with current unrestricted state licensure required, BH experience helpful.
As an equal opportunity employer, ICONMA prides itself on creating an employment environment that supports and encourages the abilities of all persons regardless of race, color, gender, age, sexual orientation, citizenship, or disability
- Business Efficiency
- Clinical Works
- Corrective And Preventive Action (Capa)
- Decision Making
- Health Administration
- Medical Necessity