The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management

…personal growth, we encourage you to apply for our Case Manager Behavioral Utilization Management opening. We promptly review all applications. Highly qualified

…appeal/denial support. . Develop and maintain expertise of regulatory guidelines regarding utilization review activities and utilization standards and

…clinical criteria and relevant Carelon Medical Benefits Management policies pertaining to utilization review . + Demonstrate and maintain knowledge of applicable

…is preferred . BSN is preferred . Certification in Case Management, Nursing or Utilization Review is preferred HCA Florida North Florida Hospital is a 523-bed,

…Management services to its clients. Care Coordinators facilitate care management and utilization review by performing data collection, data entry, and

…strongly preferred + Requires a working knowledge of community resources and Utilization /Quality Review standards. + Understanding of the hospitals patient

…Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of diagnostic imaging procedures, cardiac services and

…and cost effectiveness through the integrating and functions of case management, utilization review and management and discharge planning. Has accountability for

…+ Coordinates with other departments, ie: Pre-Admissions, Admissions, Patient Accounts, Utilization Review , PPS Coordinator, etc., to assure positive fiscal