…5 years acute care RN experience + Case Management experience Preferred: + Utilization Review or Discharge Planning Experience + Case Management Certification

…Participates and consults with team supervisor in case conferences, staff meetings, utilization review and discharge planning meetings to determine if

…in-services, provides patient referrals, and completes insurance pre-authorizations and utilization review process. Provides crisis intervention as necessary.

…to continually improve clinical outcomes and patient satisfaction. May assist in utilization review audits. + May assist manager with department operational

…practice and psychopharmacology as appropriate. + Participates in case reviews, consultations and utilization review + Responds to urgent calls from the facility

…with medical terminology and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care

…with Medicaid and Medicare populations and regulatory requirements + Experience in utilization review , skilled nursing services, home health, discharge planning,

…monthly individual counseling services to patients. + Conducts intakes, assessment and utilization review services. + Ensures compliance with all documentation

…all other Prospective Payment Systems (PPS) requirements, completing IRF-PAI sends, applying Utilization Review criteria for potential admissions as needed and

…$27.50 - $38 **Department Details** We are seeking a dedicated and detail-oriented Utilization Management Specialist RN to join our team. In this remote position,