…of utilization management including experience managing prior-authorization and concurrent review . * Knowledge of Medicare and Commercial health plans. * 3 years

…team + Assesses resident through physical assessment, interview and chart review + Discusses resident care needs with care givers, including physician,

…meets regulatory requirements. Participates in interdisciplinary communication related to utilization review issues. Educates on status. Provides all

…plan, implement and evaluate individual healthcare needs. Integrate Discharge Planning, Utilization Review and Performance Improvement activities at the patient,

…an RN or Case Manager, preferably within the last 5 years. Utilization Review and Case Management experience preferred. **Licensure/Certification:** Currently

…in the maintenance of department logs and databases, department statistics, and utilization review documents according to hospital policy and state/ federal

…measures including sentinel event review + Actively participant of the Utilization Review process and follow proper procedures. **YesCare Benefits** (only

…the data collection and review of information gathered for drug utilization review and/or research, quality improvement monitors, adverse drug event

…(pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management/ Utilization Review personnel, as needed. Obtains and

…(2) years acute care and/or community health nursing + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or