…about their care options and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all requirements 5. Explain test

…and Company guidelines + Maintains computer inventory and records to ensure proper utilization of materials and accounting for Rx drugs + Performs general laboratory

…for documentation of vital signs, chief complaint(s), preforms medication(s) review , and discusses/reviews medical and social history (as appropriate). Documents,

…Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and

…assessments including case-mix, OBRA and OSRA required assessments.*Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture

…preferred + One year of medical office, care coordination, or utilization experience highly preferred + Medical Assistant Certification or LPN/LVN preferred

…obtains action approval from director and division head or chair. + Tracks utilization , lead-time, and all other access related issues. + Presents data regularly to

…to AP peers and meets with their teams routinely (monthly) to provide updates, review areas for improvement, and listen and respond to issues. . Assists with

…management, including product evaluation, prevention of waste and damage, room utilization , control of overtime, and appropriate staffing mix. 7. Facilitates

Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness of healthcare services and treatment as prescribed