05/22, 05/24, 24, CARELON Global Solutions (Formerly known as Legato Health Technologies), Nurse Medical Management, 8, Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts., Ensures member access to medically necessary, quality healthcare in a cost-effective setting according to contract., Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process., Collaborates with providers to assess member’s needs for early identification of and proactive planning for discharge planning., Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications., Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards., Requires a BSN, current active unrestricted RN license to practice as a health professional in applicable state(s) of the United States, and 2 years of acute care clinical experience or case management, utilization management or managed care experience, which would provide an equivalent background.