Teams at PacificSource Health Plans

Provide utilization management and case review for members, coordinating resources and discharge planning, performing concurrent reviews and prior authorization assessments, documenting case notes, negotiating with providers, and supporting multidisciplinary teams to ensure quality, cost-effective care.

Perform utilization management reviews and concurrent review for inpatient and behavioral health care. Coordinate resources, discharge planning, preauthorization reviews, vendor negotiations, and member navigation. Document case notes, collaborate with multidisciplinary teams, refer high-cost cases, and assist Medical Director with guidelines and procedures to promote quality, cost-effective outcomes.

Perform utilization management and care coordination for health plan members, including concurrent review, preauthorization assessment, discharge planning, vendor negotiation, and documentation. Collaborate with multidisciplinary teams and providers to ensure appropriate, cost-effective care while supporting members and assisting Medical Director with guidelines.