…outcomes. * Leverage extensive knowledge of health care delivery system, utilization management, reimbursement methods and treatment protocols for DSNP/MMP and other

…funds and property; assure security and accuracy; audit, monitor, and review individual's financial accounts + Implement proactive strategies to reduce or

…areas, with the cooperation of staff members. + Maintains knowledge base and utilization of contract pricing, keeping current. + Responsible for and oversees the

…Completes all necessary documentation as outlined by departmental policy and documentation review . This includes, but is not limited to patient care charting, charge

…of medical claims review processes, medical necessity guidelines, and utilization review practices. + Proficiency in medical terminology, coding procedures,

…+ Assist in preparation, coordination, and participation in and follow up of Utilization Management audits, such as readiness review , Data Validation, CMS

…and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the completion of a

…documents clinical interventions, participates in quality assurance monitors, drug utilization review , and pharmacoeconomic analysis, and monitors medication

…guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality

…participate in facility meetings as directed by Center Manager (may include utilization review , infection control, disaster preparedness, etc.). + Communicate