…meets operational goals and compliance standards. **2. Process Optimization:** + Review and refine pre-certification processes to improve efficiency and accuracy. +

…Patient-Centered Medical Home processes and provide documentation demonstrating performance. + Review the medical record for quality and utilization indicators

…is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting

…position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving

…non-clinical activities that impact health care quality, cost and outcomes. * Direct the utilization review process and oversee the quality of utilization

… utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality

…authorizations for Home Health services from insurance company. 7. Attend quarterly Utilization Review meetings as designated by the Director of Professional

…resolve conflict. Promotes a positive customer relations environment. Coordinates the utilization review function for assigned patients. Performs periodic

… Review Organization a Plus **Preferred Qualifications:** -Health plan/payor Utilization Management / Review experience. -Electronic medical systems/record

…research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance counseling, pastoral counseling, or