Potential Quality of Care Quality Management Behavioral Health Nurse Consultant - Miami-Fort Lauderdale Area
1 week ago
Job summary
We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience.+
Responsibilities
- Works BH Potential Quality of Care cases,
along with Patient Safety Events across all lines of business (Commercial, Medicare, and Medicaid). Independently coordinates the clinical resolution with internal/external clinician support as required. - Reviews documentation and evaluates BH Potential Quality of Care issues based on clinical policies and benefit determinations.
The incumbent must demonstrate strong clinical judgement as well as knowledge of internal systems.
Job description
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