…responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient

… utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality

…review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and

…located within hospital + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. Preferred + Bachelor's Degree in Nursing

…include care management, interpreting dental/medical policy, quality improvement, disease management, utilization review , and dental/medical claims review ,

…Two(2)yearsclinicalnursingexperience. + One (1) year previous case management or utilization review experience. _Preferred:_ + BSN. +

…quality improvement in a nursing work environment + 2+ years' experience with utilization review audits + 2+ years' experience auditing within electronic health

…but not limited to the Clinical Effectiveness Committee, monthly facility specific Utilization Review Committees and Chief Medical Officers reports. Conducts

…Participates in departmental and interdepartmental staff meetings, in-services, utilization review programs, committees and staff/student preceptor

…health care program in which financial eligibility criteria must be met; performing utilization review , including pre-payment or post-payment review of