MedWatch, LLC

Manager

• Manages an individual caseload using the Case Management process
• Authorization of services
• Review of treatment plans for medical necessity
• Ongoing communication with all members of the health care team
• Review all medical data which can be provided to establish, update and maintain accountability for a Case Management plan
• Assess problems and determine goals and actions designed to meet the needs of the patient and document this into case notes
• Determine if these goals are long term or short term and how the patient can be expected to meet those goals
• Adhere to all company policies as stated in the employee handbook
• Participate in the Quality Management Program by adhering to all company policies and procedures and identifying opportunities for improvement

Case Manager – Specialty, RN

Support Engineer

• Analyzing, designing, implementing, and supporting business applications and systems
• Elicit, analyze, communicate, and validate business/user requirements for processes, policies, and systems
• Translate business needs/end-user requirements into functional specifications that describe what the system, process or product/service must do
• Demonstrate ability to learn to configure supported systems to meet defined functional requirements
• Assist in the execution of detailed system level application support and issue resolution
• Formulates and defines system scope and objectives through research and fact-finding combined with an understanding of applicable systems and industry requirements
• Recommends system usage improvements to enhance departmental workflow and efficiency
• Serve as a liaison between business groups and IT Development to clarify requirements, review recommendations and answer questions
• Identify/documents how applications and systems interact to support business processes
• Verify through testing that changes made by programmers to one part of the application do not impact other parts
• Create training documents and facilitate user training on new systems and/or process implementations

Application Support Analyst

Medical Reviewer

• Conduct the Utilization Review process by obtaining medical information and confirming the medical necessity of hospital admissions and/or outpatient procedures
• Identify her/himself by first name, title, and organization name when a call is made to or received from a facility, provider, or patient
• Perform preadmission review for medical necessity of hospitalization and surgery
• Assign diary date for review of continued hospital stay
• Perform review for necessity of Second Surgical Opinions
• Precert physical therapy for medical necessity
• Perform review of medical necessity for designated outpatient tests and durable medical equipment
• Perform initial and concurrent reviews during hospital stays
• Notify claims office and re-insurer
• Conduct phone inquiries to hospital/physician personnel regarding patient continued stay treatment and discharge status

Medical Review Specialist, RN

Bilingual

• Assists the RN Case Manager in performing necessary functions using the Case Management process
• Authorization of services
• Review of treatment plans for medical necessity
• Ongoing communication with all members of the health care team
• Performs all functions under the direct management and supervision of the RN Case Manager
• Communicates in both Spanish and English to service customers

Case Manager – Specialty, RN

Application Support Analyst

Medical Review Specialist, RN

Bilingual Case Manager Assistant – LVN