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Case Manager - Utilization Review
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$36 - $48 an hour
Full-time
- As a Case Manager in Utilization Review, you will perform integrated case management and disease management activities, demonstrating clinical judgment and independent analysis.
- You will apply detailed knowledge of established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case.
- You will also provide guidance to the provider network via telephone triage, perform effective discharge planning, collaborate with member support system and health care professionals involved in the continuum of care, and make referrals to appropriate departments.
- acute care experience or surgery experience/ Case Management Experience
- Knowledge of MCG Medical Necessity criteria
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