…a minimum of 5 years of combined experience in direct patient care and utilization review , quality, audit or clinical compliance; or any combination of education

…Management activities of the Agency and interface with the hospital. Oversees Utilization Review process. Manages/directs the activities of designated agency

…Federal, State, and MCHD standards for health care providers Knowledge of utilization review and case management procedures. Personal computer skills. Excellent

…patient/family assessment and multidisciplinary collaboration. 2. Ensures daily chart review , utilization reviews, coordination of discharge planning activities

…assigned physician block and reporting of physician block time assignment and utilization to directors and committees. Ongoing review of departmental equipment

…appeal decision . Provide explanations and interpretations within area of expertise . Review formulary and utilization management guidelines to determine if the

…to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patients resources and right to

…or needs. + Under direction of supervisor, establish appropriate therapeutic boundaries, utilization of identified clinical resources to review boundaries, limit

…face to face assessments that include a clinical assessment and treatment, a review of the medical, functional, behavioral, pharmaceutical, and social needs of the

**_JOB TITLE: CARE REVIEW CLINICIAN, PRIOR AUTHORIZATION (REGISTERED NURSE, OR LVN)_** **For this position we are seeking a Nurse with previous experience in Prior