KATHRYN SCOTT

RN Care Navigator in Utilization Management for Populytics

Performing prior authorizations for all types of services requiring authorization per the employee health plan.

Applying review of IQ criteria for prior authorization

Collaborating with Medical Director for appropriate determination per Health Plan Guidelines.

Outreach as needed to Practitioner offices, Hospital Departments, EPIC documentation to assure optimal review and accuracy.

Case Management for Complex and high dollar patients as needed.

Evaluated medical guidelines and benefit coverage to determine appropriateness of services.

Performed prior authorization review of services requiring notification.

Performed admission reviews for medical necessity based upon specification.

Obtained authorization from various insurance carriers for multiple levels of care.

Effectively communicated with physicians and interdisciplinary team re patient needs.

Completed initial assessments of patients and family to address individual discharge needs.

Facilitated appropriate reimbursement through Utilization review and communication with various insurance companies for hospital admission and dc planning.