…using electronic clinical systems in the payer setting 5 years hands-on experience in utilization and coverage review in a health plan with Commercial membership

…member cases by coordinating the provisions of services, assuring the cost-effective utilization of health care resources to meet individual members health care

…status summaries. Participate in audits of programs to ensure agency compliance on utilization review regulations. Must have strong analytical skills and pay

…and the needs of third party payers in a timely manner.Assist in admissions review , concurrent reviews and discharge planning.Assist physician in peer review by

…of quality and cost improvement that is data driven and develops systems to review utilization of resources and objectively measure outcomes of care in the

…and legal access to information on the care of patients.Facilitate peer review calls between facility and external organizations.Act in coordination with the

Maxim Healthcare Services is seeking 5-6 RNs for position as Utilization Management Coordinator. These openings are with a prestigious Managed Care Organization in

…care. .Monitors quality and safety, patient satisfaction, risk management, and utilization review , and develops performance improvement plans. .Works with

…in and passion for program design and implementation. Experience in program evaluation/ utilization review . In-depth knowledge of ASAM Patient Placement Criteria.

…Work Experience: Three or more years of experience in case management, utilization review , or discharge planning required. Equal Employment Opportunity AMITA