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Case Manager Utilization Review
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$36.39 an hour
Full-time
- The UR Case Manager follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.
- Under general supervision of the Utilization Management Manager, the Utilization Management Nurse will monitor and manage all inpatient hospital admissions with the goal of achieving cost- effective patient care.
- Identifies when those situations where criteria is not met for admission and discuss issues with the attending physician; Utilize clinical skills, chart review, physician communication and Interqual Level of Care and utilize peer review as necessary.
- The primary areas of responsibilities are: concurrent utilization review, retrospective and/or denials management and interactions with department and staff of TGH to ensure good patient flow through appropriate status and medical necessity designations.
- Concurrent Denials Management Interdisciplinary discussions and physician partnerships
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