…of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures. Please note that

…and reporting information as required by department and other programs. * Provides utilization review functions as required by the department. * Identifies

…Responsibilities: Leads medical management initiatives for assigned markets to include utilization management, concurrent review , and case management. Ensures

Utilization Management Specialist Durham, NC **100% Remote** Contract $17/hr - $17/hr Our client, a nationally recognized and award-winning company in the health

…information, member plan benefits and how to access those benefits, and appropriate utilization of services based on need. . Review member health-related

…promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member,

…the clients' responses to the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion but not less than every

…Responsibilities:** + Lead initiative on point-of-service collections at each office. + Review denials and identify areas needing improvement. + Work closely with

…**Essential functions include** : + Facilitates pharmaceutical care services, medication utilization systems within assigned services and care areas to ensure drug

…measures, designs data collection instruments, and conducts quality, compliance and utilization reviews. * Ensures Quality Improvement programs are aligned with CMS