…of medical claims review processes, medical necessity guidelines, and utilization review practices. + Proficiency in medical terminology, coding procedures,

…+ Assist in preparation, coordination, and participation in and follow up of Utilization Management audits, such as readiness review , Data Validation, CMS

…and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the completion of a

…documents clinical interventions, participates in quality assurance monitors, drug utilization review , and pharmacoeconomic analysis, and monitors medication

…guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality

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

…agencies and payers to plan and execute a safe discharge* Collaborates with Utilization Management team on continued stay review . + Discharge Planning*

…Physician Clinical Reviewer- GI- REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service

…Manage pay practices including accurate time card review and approval, review and manage all overtime utilization . Assists with the implementation of

…Completes all necessary documentation as outlined by departmental policy and documentation review . This includes, but is not limited to, patient care charting,