…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

…**(2 openings)** **_For this position we are seeking a Registered Nurse with previous Utilization Review / Utilization Management and knowledge of Interqual

…care and cost effectiveness through the integrating and functions of care management, utilization review and discharge planning. The Care Manager must be highly

…bodies within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. +