Lucent Health

Manager

• Work with the entire team to provide appropriate, comprehensive, and proactive onsite and telephonic case management services
• Define role and scope of activities to the patient in a comprehensible manner
• Gather consent for case management activities and determine individual needs based on an assessment
• Create an individualized plan of action based on the assessment and facilitates treatment coordination
• Set appropriate, measurable goals and provide the patient with information to empower decisions
• Develop contingency plans and monitor the provision of the coordinated plan
• Evaluate plan on a regular basis to determine effectiveness and patient's needs
• Refer to only those providers that ensure high quality
• Identify and coordinate resources to ensure success of the plan

Complex Case Manager, RN

• Performs all phases of the case management process which shall include: Assessment
• Planning and Coordination: Creates an individualized plan of action based on the assessment
• Implementation and Monitoring: Implements a plan that is based on the assessment.
• Evaluation: Evaluates plan on a regular basis to determine effectiveness, patient satisfaction, provider comfort.

Maternity Case Manager, RN

Analyst

• Evaluate large medical and pharmacy claims for stop loss reimbursement eligibility
• Assist in preparation and submission of stop loss claims to carriers, ensuring compliance with contract terms
• Monitor reimbursements and maintain status updates on pending claims
• Collaborate with internal departments (Claims, Care Management, Finance) to gather documentation
• Liaise with stop loss carriers to resolve claim issues and provide necessary support
• Maintain detailed records in accordance with regulatory and HIPAA standards
• Identify process inefficiencies and recommend improvements to optimize claims cycle time

Complex Case Manager, RN

Maternity Case Manager, RN

Stop Loss Analyst