UTILIZATION MANAGEMENT RN
: Job Details :

Day-to-day management of Utilization Management queues, dashboards, members, ensuring all Utilization Management activities, which include authorization timeliness, discharge planning, adherence to policies and procedures to ensure high quality and cost-effective utilization management services. Ability to work decision letters timely and accurately Quality monitoring focusing on medical necessity guidelines and discharge planning opportunities to lower levels of care Assist the Director of Utilization Management with the Utilization Management Reports to be reviewed by Executive Leadership. Ability to contribute to the UM team to ensure compliant execution of UM program Review admissions and service requests for the following: Authorization requests to ensure appropriate care for members and within clinical guidelines Monitor members both inpatient/outpatient provide updates to Director of Utilization Management and the clinical care teams Recommend more appropriate care if required A...RN, Management, Registered Nurse, Healthcare, Skills