…skills to evaluate the quality and effectiveness of case management and/or utilization review decision-making + Additional duties as assigned **Minimum

…for performing clinical consults according to pharmacy guidelines and conducting ongoing drug utilization review to promote effective, safe and efficient use of

…with eligible inpatients and Partial program patients and also may perform utilization review for this patient population2. Provides discharge planning and

…complex problems in the areas of census verification, bed assignment and utilization review . + Ensures compliance with hospital departmental policies and

…of experience in care/case management, disease management, population health management, utilization review , quality assurance, or discharge planning (preferably

…or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education

…response to therapeutic interventions via collateral calls, conjoint therapy sessions, utilization review process, and/or referrals and revises care plan

…experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes and/or

…third-party authorizations, referrals) and will contact the physician and Case Management/ Utilization Review personnel, as necessary. + Informs patient/guarantor

…or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education