…Increased productivity, market share, quality improvement, cost controls, and optimum utilization of facilities. Collaborates with Finance and Managed Care, as

…lives.** Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission

Registered Nurse (RN) Case Manager/ Utilization Review - North Emergency Job Ref 2408203 Category Nursing Job Family Case Manager Department Case Management

…must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US

…program, this position may be asked to participate in various aspects of utilization review . For example, compose clinical letters in reply to third-party

…He/she is knowledgeable of the MISSION Act, COMPACT Act, VHA guidelines, utilization review mechanisms and evidence-based standards. Uses advanced clinical

…measures including sentinel event review + Actively participant of the Utilization Review process and follow proper procedures. **YesCare Benefits** (only

…and referral needs. Per referral guidelines, provide appropriate clinical information to Utilization Review Nurses. + Makes outbound calls to obtains supporting

…+ Knowledge of computer technology, quality assurance activities, DRG, Quality Insights/ Utilization review background is highly preferred. + Ability to

…as required. 2. Ensures effective program participation in VAMC quality assurance and utilization review workload data capture and CPRS documentation by staff