…as supporting on-going quality assurance needs for coding staff. They will review medical records and documentation for coding accuracy, providing feedback, and

…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,