To provide support to the clinical team and client team to assist in the promotion of quality member outcomes, to optimize member benefits, and to promote effective use of resources. Supports the procedures that ensure adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective. Utilization Management: Gathers information using the appropriate client-specific telephonic screening tools. Conducts pre-review screening under the guidance and direction of US licensed health professionals. Case Management/Disease Management - Provides support functions for wellness programs, health management programs and preventative care opportunities that the member may have as part of their benefits. Gathers information using the appropriate client-specific telephonic screening tools.
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