POSITION SUMMARY: Performs concurrent utilization review activities on all patients within the assigned caseload.... Collaborates and educates the medical staff on appropriate utilization review guidelines and documentation in accordance with CMS...
for Utilization Management, Denials /Appeals Management, Resource / LOS management. Accountable for directing the day-to-day... operations for Concurrent Utilization Review processes for Medicare, Medicaid, Managed Care and Commercial Payors, Oversight...
) from both a discharge planning and utilization review perspective. Performs concurrent utilization review activities on all patients... within the assigned caseload. Collaborates and educates the medical staff on appropriate utilization review guidelines...
relates to a multidisciplinary approach to patient care and utilization of resources. EDUCATION: Bachelor's degree... required. ANCC case management certification preferred. EXPERIENCE: Minimum five years experience in utilization review...