…process. + 3 years' experience working in a managed care environment supporting utilization management and case review with medical necessity determinations. +

…Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care

…care team, or other specialty care. Coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization

…Interqual criteria **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina

…care givers, and families. Their functions include concurrent and retrospective review to assure appropriate utilization , assessment, prevention of denials

…research, and patient care missions of the University's Medical Center. * Review , establish, and revise policies, procedures, and standards related to all aspects

…requirements relative to the case management process. Certified to complete Patient Review Instruments (PRIs). Has a working knowledge of the hospital computer

…quality control/timeliness of reporting + Extracts, collects, analyzes and interprets health utilization and financial data of various types + Interpret an analyze

…others as applicable. * Evaluates branch operations; analyzes trends in volume, utilization , and other business drivers to understand the impact these factors have

…those involved in formulary management (such as, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such