…identified patients and family needs with the efficacious and cost-effective utilization of resources. + Through concurrent case management, patients will be

…Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in collaboration with the

…our employees both professionally and personally. We are seeking a detail-oriented Utilization Review Registered Nurse to be responsible for prior authorizations

…admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for

…+ 3 - 5 years in Care Management + 3 - 5 years in Utilization Review + 3 - 5 years in the Health Insurance Industry **LICENSES AND CERTIFICATIONS** **Required**

…Masters preferred. + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. +

…leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee

…pertaining to their practice. Performs other duties as assigned, including utilization review as necessary. **Qualifications** Graduate of an accredited

…and coding principles and guidelines; good knowledge of healthcare delivery system, utilization review , case review and quality improvement practice

…words per minute with 0-2 errors; proof work.Maintain knowledge of insurance, utilization review , scheduling requirements and support of front desk