…and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making

…mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4

…mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4

…HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF UTILIZATION

…providers on the health plan's pharmacy process + Assist with the pharmacy utilization review and reporting process + Collaborate with Quality Improvement

…plans. + Responsible for oversight of the care coordination, social work and utilization review department's processes in accordance with federal, state, and

…or services (with complete cost/benefit analysis). Oversees all CQI and utilization review activities. Assists in agency evaluation activities. Participates

…illness, and/or life situation. Performs other duties as assigned. Responsibilities + Utilization Review and precertification + Discharge planning + Readmission

…of experience in care/case management, disease management, population health management, utilization review , quality assurance or discharge planning (preferably

…on an **acute/critical care** unit, organ donation/transplant unit, in tissue/blood banking, utilization review and/or case management with critical care skill