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Patient Health Risk Educator
Description:
- Conduct detailed utilization reviews to evaluate the necessity and appropriateness of patient care.
- Assess clinical documentation against medical guidelines to determine treatment eligibility.
- Review patient cases to ensure alignment with established care protocols and best practices.
- Evaluate patient progress and update treatment plans accordingly.
- Coordinate with multidisciplinary teams to establish patient care benchmarks.
- Monitor ongoing treatment to ensure compliance with quality care standards.
- Perform retrospective reviews to determine if inpatient admissions were medically necessary.
- Consult with physicians to confirm medical justifications for extended care.
- Collaborate with treatment teams to resolve discrepancies in case documentation.
- Oversee timely benefit determinations in compliance with company standards.
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