…the application of strict program inclusion/exclusion criteria. + Demonstrates appropriate utilization of resources necessary to obtain valid, reliable data for

…determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.

…chart documentation. 8. Incorporates use of criteria sets in context of utilization management. 9. Performs other related duties as assigned. Required: 1. Master's

…the patient with a payment receipt. + Validates medical necessity (LMRP/LCD review ) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.

…in the most efficient and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will

…**Shift:** Rotating Shift **Description:** Requires BSN At **Mercy Medical Center** the ** Utilization Review /Appeals & Denials** **RN** performs utilization

Utilization Review Specialist Job Details Job Location Henderson - 1711 Whitney Mesa - Henderson, NV Position Type Full Time Education Level 2 Year Degree Salary

…setting, behavioral health setting, drug and alcohol setting, managed care, quality management/ utilization review or other related clinical experience; or An

…facilitate the progress of completing complex post-acute services + Interface with utilization review specialists to stay current on patient's eligibility for

…patients. Serves as a liaison to the facility-based leaders, including Utilization Review Manager, facility-based Clinical Documentation Improvement Specialists,