. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior.... In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial and concurrent...
for Utilization Management and works collaboratively with Utilization Management/Concurrent Review Nurse, physicians, staff... Utilization Management/Concurrent Review Nurse within identified process standards • Reviews any service denials and gathers...
required. Minimum one (1) year of quality/utilization review experience required. Experience with research, data retrieval, data analysis..., the Clinical Appeals Specialist will review medical necessity requests, render determinations about appropriateness...
on committees such as placement, utilization review, and medical records review; and preparing periodic performance evaluations... Pathologist 2, Teacher 4 (and all parenthetics), Training Specialist 1 (Nursing), and Utilization Review Coordinator. Candidates...
. The Medicaid Special Programs Registered Nurse Case Manager is responsible and accountable for coordinating the care... of quality, clinical and cost outcomes. In addition, the Medicaid Special Programs Registered Nurse Case Manager is responsible...