…with previous managerial or leadership experience required. . Prior experience in utilization /quality review and/or PRO review required or equivalent

**Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical information

…payers to assist in planning and executing a safe discharge. + Collaborate with Utilization Management team on continued stay review . + Educates patients and

…and maintains all aspects of the scheduling process to ensure optimal utilization of surgical services. Establishes and maintains computer procedures for scheduling

…serve as a subject matter expert in FANS standardization and utilization , clinical nutrition, technology utilization , patient satisfaction, employee engagement,

…no more than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. Analyzes assessment data to

…regulations. + Prepare and present regular reports on quality, population health, and utilization management metrics. + Serve as a liaison between members and the

…information from the Operations and Medical Management teams. Assesses and performs review of member clinical records and services related to behavioral health and

…information from the Operations and Medical Management teams. Assesses and performs review of member clinical records and services related to behavioral health and

…managing psychiatric and substance abuse health benefits through telephonic or written review and providing clinical crisis support of the 24/7/365 Behavioral Health