Case reviewer vs case management coordinator

Differences between case reviewer and case management coordinator duties and responsibilities

Case reviewer example responsibilities.

• Manage afive person team responsible for covering scope, assigning, analysis and then final review ofInvestigation ROI.
• Require a broad and comprehensive knowledge of Medicaid policies, code references, and compliance.
• Provide education to physicians/office staff on aspects of HEDIS medical record documentation, compliance, and regulatory criteria.
• Participate in meetings with inter agencies and other entities as appropriate to facilitate and enhance the Medicaid eligibility determination process.
• Communicate regularly with client and travele frequently to arbitration site.
• Assist in preparation of witnesses and exhibits for depositions and arbitration hearings.
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Case management coordinator example responsibilities.

• Manage caseload by providing care coordination to individuals with a primary intellectual/developmental disability diagnosis all of whom receive community-base waiver services.
• Discharge planning including but not limit to rehabilitation, durable medical equipment and home healthcare.
• Provide counseling support to clients with mental illness, HIV/AIDS, autism, and handicaps.
• Act as medical resource for appeals function.
• Input client's information into HMIS portal database.
• Design custom reports within AVAYA CMS used to assist with forecast and staff implementation.
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