…Federal or State regulations pertaining to their practice. + Have an understanding of Utilization Review to progress plan of care. + Understand how

…will include intensive case management, contributing to treatment planning, participating in utilization review for IOP level of care, and conducting a

…or similar clinical experience OR + 5 years experience in Medical Review , Utilization Management or Case Management at CareFirst BlueCross BlueShield,

…psychiatric setting. **Preferred Qualifications:** + 2 years' experience in Medical Review , Utilization Management or Case Management at CareFirst BlueCross

…efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality

…relationships. Participates in departmental and interdepartmental staff meetings, in-services, utilization review programs, committees and student preceptor

…compliance with regulatory, MTF, and Joint Commission quality inspection/peer review / utilization management requirements, applicable system applications, and

…health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review

…will provide analytics support for HMC's growing Care Management and Utilization Management as well as collaborate with ambulatory stakeholderson priority quality

…Operations and ambulatory directors, determines, monitors and ensures that productivity and utilization goals are met for all clinics + Maintain quality patient care