…2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred **Schedule** Per Diem

…Experience* *Required*- Three years of nursing experience. *Preferred*- Experience in utilization review , case management, discharge planning, and clinical

…record keeping as necessary for program accountability + Participates in monthly Utilization Review , quality assurance and program evaluation activities as

…You will promote cost effectiveness through the integration of case management, utilization review management and discharge planning. **What qualifications you

…management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission process

…and inpatient care + Participate in rotating night and weekend call + Review outcome and utilization data, including adverse events, hospitalizations, and use

…application of strict inclusion/exclusion criteria and protocols. + Performs meticulous chart review and enters clinical data into the quality databases to identify

…to, working collaboratively with Plan departments and will be responsible for review and interpretation of current medical policies for systematization. Must be able

…and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the

…annual thereafter) follow-up data components for the program through the effective utilization of the hospital medical record systems and through a coordinated