(Telecommute) / HEALTHNET VA FEDERAL SERVICES Registered Nurse Managed Care / Medical Management Utilization Review Nurse, Care Coordination, Provider Relations
- Utilized McKesson InterQual Criteria, performing first level clinical reviews for all inpatient and ancillary services requiring authorization.
- Assisted in requirements gathering for policies and procedures, internal audits, and reporting
- Completed 20+ discharge calls daily to decrease re-admittance and hospitalization and to ensure post-op care is followed.
- Performed case management, disease management, and care coordination for veterans between PCCC and non-VA providers.
