Healthgram is seeking someone to fill our brand-new role as an RN Medical Liaison. In this position, you will play a dual role in managing reviews for medical necessity and providing compassionate member advocacy.
Clinical Review & Authorization: Conduct comprehensive utilization reviews for medications, DME, and Home Health services, ensuring all treatments meet medical necessity criteria and FDA approvals.
Care Coordination: Actively manage member cases by anticipating needs, researching treatment regimens, and communicating with providers to implement and monitor effective plans of care.
Member Advocacy & Education: Serve as an empathetic clinical resource for members and their families, helping them navigate benefits, understand their disease, and manage the emotional challenges of their diagnosis.
Administrative Oversight: Generate daily precertification reports, manage online authorization queues, and conduct claims reviews to ensure clinical documentation aligns with billed services.
Collaborative Support: Provide peer-to-peer clinical consultation for teammates and handle miscellaneous high-priority authorizations or special projects as assigned.
