…an RN or Case Manager, preferably within the last 5 years. Utilization Review and Case Management experience preferred. **Licensure/Certification:** Currently

…in the maintenance of department logs and databases, department statistics, and utilization review documents according to hospital policy and state/ federal

…measures including sentinel event review + Actively participant of the Utilization Review process and follow proper procedures. **YesCare Benefits** (only

…the data collection and review of information gathered for drug utilization review and/or research, quality improvement monitors, adverse drug event

…(pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management/ Utilization Review personnel, as needed. Obtains and

…(2) years acute care and/or community health nursing + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or

…and direction to the Quality Management Programming designing and evaluating protocols. + Review the medical aspects of cost and utilization reports generated by

…care givers, and families. Their functions include concurrent and retrospective review to assure appropriate utilization , assessment, prevention of denials

…and external to the organization, to improve patient care through effective utilization and monitoring of healthcare resources and assumes a leadership role to

…as patient flow, patient satisfaction, practice volume, billing and collections, service utilization , coding, physician and staff training + You will have strategic