…of utilization management + Medicare, Medicaid, and commercial admission and review requirements + In-depth knowledge of utilization management processes and

…experience; or equivalent of education and experience in case management, utilization management or prior clinical documentation review experience, required

…and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource

…face to face assessments that include a clinical assessment and treatment, a review of the medical, functional, behavioral, pharmaceutical, and social needs of the

…+ Facilitates pharmaceutical care services, direct patient care programs, medication utilization systems within assigned services and care areas to assure drug

…related to clinical guidelines, coding requirements, regulatory requirements, and resource utilization . This includes using vast clinical knowledge to ensure correct

…classes and community education programs for the orthopedic patient. (Provides annual review of all materials.) Done in collaboration with orthopedic care team. +

…by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities The Home Based Primary Care Physician

…in the Pharmacy & Therapeutics (P&T) Committee and the Pharmacy Logistics Utilization Management (PLUM) Meeting. *PRIMARY ACCOUNTABILITIES * * Maintains a safe

…urgent care within the home in order to prevent avoidable Emergency Department utilization . This is a part time position. 6-12 hour shifts, 12pm-12am / minimum