…located within hospital + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. Preferred + Bachelor's Degree in Nursing

…clinical nursing required. Two years experience with case management, discharge planning, utilization review and/or home care required. Knowledge of the

…include care management, interpreting dental/medical policy, quality improvement, disease management, utilization review , and dental/medical claims review ,

…bodies within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. +

…Two(2)yearsclinicalnursingexperience. + One (1) year previous case management or utilization review experience. _Preferred:_ + BSN. +

…but not limited to the Clinical Effectiveness Committee, monthly facility specific Utilization Review Committees and Chief Medical Officers reports. Conducts

…through residency training or prior job experience. 4. Experience in drug utilization review and analysis. **Duties and Responsibilities** **:** The duties

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

…Management or Critical Care is preferred. + Certification in Case Management or Utilization Review is preferred. + InterQual experience is preferred. Colleton

…health care program in which financial eligibility criteria must be met; performing utilization review , including pre-payment or post-payment review of