…pharmacy and if required, will perform benefit overrides based on the drug utilization criteria/protocol as defined by ASES, CMS or exception process. Reviews the

…Nurse (RN) - 3 - 5 years of experience required Position Summary: Performs utilization review and certifies patient stays by analyzing patient medical records

…guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality

…of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures. Please note that

…and reporting information as required by department and other programs. * Provides utilization review functions as required by the department. * Identifies

…Responsibilities: Leads medical management initiatives for assigned markets to include utilization management, concurrent review , and case management. Ensures

Utilization Management Specialist Durham, NC **100% Remote** Contract $17/hr - $17/hr Our client, a nationally recognized and award-winning company in the health

…information, member plan benefits and how to access those benefits, and appropriate utilization of services based on need. . Review member health-related

…promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member,

…the clients' responses to the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion but not less than every