Position Purpose
Perform duties to direct the operations of the referral management, telephonic utilization review, prior authorization functions, and case management programs, providing support to staff and communicating with departmental and plan administrative staff to facilitate daily department functions, in accordance with government and contractual guidelines and the mission, philosophy and objectives of the health plan.
 
Knowledge/Experience
Thorough knowledge of a specialized or technical field such as clinical nursing, utilization and/or case management plus the application of basic theory. Equivalent to nursing education. Over 5 years up to 7 years recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics. Over 1 year up to 3 years management and utilization and/or case management experience. Over 5 years experience in an HMO or managed care environment.