…are seeking a (RN) Registered Nurse, with previous experience in Prior Authorizations, Utilization Review / Utilization Management and knowledge of Interqual

…You Will do + Provides oversight of VNS Health Plans clinical components for utilization review and decision making. + Leads in establishing medical policies for

…and administration of the activities of clinical review , discharge planning, resource utilization and utilization review . Graduate of a nursing program.

…managed care guidelines, best practice protocols, evidenced based care, and the utilization review processes. In partnership with the supervising physician the

…to work in a dynamic, fast-paced environment. + Preferred interest in Sleep management utilization review . For candidates working in person or remotely in the

…related to the delivery of medical care and clinical services such as utilization review , quality assurance, and medical protocol development. + Assist in

…participate in facility meetings as directed by Center Manager (may include utilization review , infection control, disaster preparedness, etc.). + Communicate

…years recent clinical experience and two years ICD-9 Coding experience (optional). Utilization Review or coding experience preferred. For Behavioral Health:

…ongoing programs related to drug therapy, such as anticoagulation program, drug utilization review , medication use and adverse drug reaction monitoring. Serves

…ED inpatient admissions and observations as specified by the facility's Utilization Management/ Review Committee for documentation completeness and compliance