…the general and specialized principles, practices, techniques and methods of Utilization review /management, discharge planning or case management. . Working

…Responsibilities: + Maintains familiarity with the laws, regulations, and interpretation of utilization review and discharge planning. Remains up to date on

…services provided by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and

…about the Hospice philosophy and Hospice's services. QUALITY ASSESSMENT/IMPROVEMENT AND UTILIZATION REVIEW : Ensures compliance with the program plan, assuring

…inpatient programs by implementation or investigation of the procedures in the Utilization Review and Discharge Planning program at Westchester Medical Center.

…Management Department, including but not limited to clinical resource management, utilization review , discharge planning, patient advocacy, oversight of nursing

…position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving

…and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Awareness of

…NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the

…and coding principles and guidelines; good knowledge of healthcare delivery system, utilization review , case review and quality improvement practice