…in the electronic medical record (EMR). 3. Responsible for the safe and accurate utilization of all aspects of the EMR and Record and Verify system. 4. Possesses

…Financial Officers, Chief Medical Officers, Patient Financial Services, Patient Access, Utilization Review , Case Management, and clinical areas including

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

…location preferences and digestive health needs. Schedules will be reviewed daily to review for openings to get patients from the waiting list or reschedule list

…7. The Case Manager independently performs clinical reviews based on the Utilization Review Plan with follow-up actions identified for medical necessity

…preferred. + Experience At least five years of clinical experience and utilization review /case management experience. Experience in determining medical necessity

…and actively participates in medical staff duties. Participates in quality assurance, utilization management, and peer review programs to ensure high quality,

…subordinate medical staff positions. Provides leadership and oversight for peer review , credentialing, and other required medical staff functions. CORE FUNCTIONS 1.

…all Revenue Management teams and departments including Practice Consultants, Utilization Management and Care Management, Providers, Geisinger departments, clinical

…interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic work