…information, inclusive of free text fields, to support the case management, utilization review process. + Retrieves information for the Physician Advisors

…assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible

…as a member of several of the hospital's Committee, and participates in utilization review , treatment teams, administration and medical staff to provide for

…committees.** **The value you'll bring to the team:** + **Facilitates clinical teams to review utilization and options for product selection for our Great Lakes

…claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required + 7+ years experience with Optum Claims

…Benefit questions to improve member experience. + Participates in Quality Improvement projects; Utilization Review ; Individual Drug Profile Review . + Serves

…needs. + Monitors and assesses the use of hospital services by administering utilization review procedures under Federal, State and hospital guidelines. +

…payers to assist in planning and executing a safe discharge. + Collaborate with Utilization Management team on continued stay review . + Educates patients and

…to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patients resources and right to

…functions. + Under direction of supervisor, establish appropriate therapeutic boundaries, utilization of identified clinical resources to review boundaries,