…HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF UTILIZATION

…providers on the health plan's pharmacy process + Assist with the pharmacy utilization review and reporting process + Collaborate with Quality Improvement

…plans. + Responsible for oversight of the care coordination, social work and utilization review department's processes in accordance with federal, state, and

…or services (with complete cost/benefit analysis). Oversees all CQI and utilization review activities. Assists in agency evaluation activities. Participates

…illness, and/or life situation. Performs other duties as assigned. Responsibilities + Utilization Review and precertification + Discharge planning + Readmission

…of experience in care/case management, disease management, population health management, utilization review , quality assurance or discharge planning (preferably

…studies and surveys with technical staff; for the purpose of quality assurance, utilization review and the overall improvement of medical programs of the

…(BLS or BCLS) and Certification. + Certification in case management or utilization review preferred. + InterQual experience preferred. HCA Healthcare's Alaska

…+ Monitor alarm controls. + Maintain effective working relations with coworkers, utilization review , outside companies, and other staff to ensure workflow