…guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality

…2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred **SCHEDULE** + Per Diem

…billing and data reporting. Work with Strong Ties leadership and Dept of Psychiatry Utilization Review team to address documentations concerns in a timely way

…experience. 5. Experience in business/development preferred. 6. Prior experience in utilization review or discharge planning preferred. 7. Certifications: CCM,

…- 28.00 **Department Details** opportunity to work remote **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients in

…Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES + Monitor

…+ Assist health plans with obtaining and maintaining NCQA accreditation for utilization management and quality assurance. + Review services that require

…intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements,

…Possesses knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements,

…Utilizes case-finding strategies to identify at risk patients, such as unit rounds, utilization of computer reports, chart review , etc. 3. Identifies educational