…evaluations with the referring agency and the client's caseworker. 2. Review all available clinically relevant material, including referral information, previous VPS

…- Coordinate time and place of evaluation with client's caseworker. - Review all available clinically relevant material, including referral information and previous

…with the care team in the provision of patient care. Performs a clinical review of selected patients to determine service needs. Coordinates the care of selected

…initial appeals and redeterminations, ensuring timely and accurate filing of utilization review procedures, and securing funding authorizations for our

…presents with special issues. Maintains case records, treatment plans, statistics and utilization rates in accordance with Navy policies and regulations and updates

…a specified patient care area, and for the acquisition, development, and utilization of resources (human and material) needed to fulfill those responsibilities. We

…RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal

…care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly

…census/ utilization in all programs they oversee. Oversees the internal utilization review process for their assigned programs. Assists the Vice-President

…(ie Med-Surg, Tele, ICU, PCU etc) + Certification in case management or utilization review preferred + InterQual experience preferred HCA Florida Northwest