…appeals and grievances. You will: + Ensuring timely, accurate, and thorough review of member and provider complaints, working closely with clinical and

Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the revenue cycle

…develops, coordinates, and implements with the direction and approval of the Utilization Review Committee and Senior Administration the processes, procedures,

…in Healthcare Quality (CPHQ) Lean Six Sigma CPUR Certified Professional in Utilization Review CPUM Certified Professional in Utilization Management

…This role includes direct involvement in patient care coordination, discharge planning, and utilization review . The Director will manage a team of case managers

…predominately in a medical-surgical setting. Case Management, discharge planning, and utilization review experience required. Skill, Knowledge and Abilities:

…and coding principles and guidelines; good knowledge of healthcare delivery system, utilization review , case review and quality improvement practice

…QA plan, drug usage evaluations medical record review , pharmacy and therapeutics review , risk management, and utilization review as reported by

…Management or Critical Care is preferred. + Certification in Case Management or Utilization Review is preferred. + InterQual experience is preferred. **Grand

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