CarePay

Manager

• Responsible for coordinating and managing inpatient and outpatient preauthorization requests in line with policy guidelines, clinical appropriateness, and cost containment objectives.
• Ensure timely review and authorization of medical requests.
• Effective follow-up of admitted members through hospital visits and phone calls.
• Close monitoring of patient progress to support quality, medically necessary, and cost-effective care.
• Oversee inpatient admissions from preauthorization through discharge, including reviewing interim bills, medical reports, treatment plans, and discharge summaries.
• Engage providers, members, and internal stakeholders to facilitate timely care decisions, manage escalations, and promote positive clinical and financial outcomes.
• Identify utilization trends, potential fraud, waste, and abuse indicators, and areas for process improvement.

Case Manager