…and actively participates in medical staff duties. Participates in quality assurance, utilization management, and peer review programs to ensure high quality,

…and actively participate in medical staff duties. Participate in quality assurance, utilization management, and peer review programs to ensure high quality,

…and actively participates in medical staff duties. Participates in quality assurance, utilization management, and peer review programs to ensure high quality,

…functions. + Under direction of supervisor, establish appropriate therapeutic boundaries, utilization of identified clinical resources to review boundaries,

…appropriate for complex case management and timely completion of all utilization management activities. Involvement in the development of case management plans.

…information presented meets medical necessity criteria or requires additional medical necessity review . + Conducts initial medical necessity review of exception

…through the application of evidence-based knowledge, analysis, in-depth review , interpretation, identification of opportunities, communication and consistent

…care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity

…outpatient and research nursing, house staff and faculty. _Responsible for resource utilization and prioritization within the Program._ + Direct meetings to discuss

…by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities This position will be located at