…You will promote cost effectiveness through the integration of case management, utilization review management and discharge planning. **What qualifications you

…of subordinate nurses engaged in quality assurance, infection control, and utilization review activities. + Receives physicians' instructions regarding resident

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

…reports, documentation and billing in a timely manner. Ensure that documentation meets utilization review and quality assurance standards. + May be required to

…clinical record. *Maintain patient caseload (including all case management and utilization review updates, treatment planning duties, and clinical charting

…and familiarity with HEDIS measure specifications. * Prior work in utilization management, quality management/ review , accreditation, outpatient clinic setting or

…to join one of our Fortune 500 clients. **Job Summary** The Medical Review and Utilization Management Specialist is responsible for performing medical reviews

…Communicate kept appointments without charges, CME/license/dues annual reports, and monthly slot utilization reports. 2. Quality Assurance: * Review charts for

…ensure effective care coordination + At the direction of the Medical Director, review outcomes and utilization data, including hospitalizations, and use of

…throughout the hospital stay for the appropriate level of care and utilization of resources. The case manager will perform transition care planning activities