Manager enabling Services Programs at Mastercard, focusing on program management and performance evaluations. Engaging with leadership and advocating for project success across the organization.
About the role
- Clinical review role authorizing medical services that meet criteria in a healthcare setting. Facilitating referrals and managing case management processes.
Responsibilities
- Performs clinical/medical necessity reviews
- Authorizes medical services that meet medical criteria
- Facilitates referrals to providers or vendors
- Communicates decisions to appropriate persons and documents per UM policy
- Reviews patients for multiple diagnoses and refers for case management if needed
- Attends and actively participates in department/team process/quality improvement activities
Requirements
- 2 Years Experience in a medical setting (i.e. office, hospital, SNF, medical clinic etc.)
- California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians -REQUIRED
- Experience in managed care
Benefits
- Health insurance
- 401(k) matching
- Paid time off
- Professional development opportunities
Job title
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