…development of standards of care and protocols, which may include literature review , development of standards of care/protocols, chart reviews, data analysis, and

…quality. + Execute regional core growth strategy to increase census, maximize utilization and occupancy percentages; respond to local requests for proposals to

…records to ensure the necessity and appropriateness of care provided. 3. Utilization Review : Conduct thorough utilization reviews, applying evidence-based

…staff as needed with assuring compliance with external and internal utilization review /quality and appropriateness requirements. What qualifications do you

…pertaining to their practice. 13. Performs other duties as assigned including utilization review as necessary. **Qualifications** **Required** + Graduate of an

…identify patients at high risk for readmission. * Interfaces effectively with the Utilization Review department to stay current on patient's eligibility for

…and patient care as indicated and required; + May participate in quality assurance/ utilization review or other non-direct patient care nursing assignments; and +

…NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the

…**Experience** Preferred * 3-5 years of related experience. * Case management, utilization review , or discharge planning experience in an acute, rehabilitation,

…No weekends or holidays will be required **Preferred Qualifications** + Managed care/ utilization review experience preferred. + Case Management and discharge