Utilization Review Nurse
Current• Participate in and or lead intradepartmental teams, projects and initiatives• Consult with clinical reviewers, medical directors and providers to ensure medically appropriate, high-quality, cost effective care throughout the medical management process• Conduct recertification reviews for initial/ continued stay reviews for inpatient, skilled nursing facilities (SNF), inpatient rehab (IPR), long-term acute care (LTAC) and elective procedures including chemotherapy for oncology… Show more • Participate in and or lead intradepartmental teams, projects and initiatives• Consult with clinical reviewers, medical directors and providers to ensure medically appropriate, high-quality, cost effective care throughout the medical management process• Conduct recertification reviews for initial/ continued stay reviews for inpatient, skilled nursing facilities (SNF), inpatient rehab (IPR), long-term acute care (LTAC) and elective procedures including chemotherapy for oncology patients• Review/redirect providers for Out of Network Service requests• Well versed with ACMP, Milliman guidelines, Anthem Medical Policy, and American Imaging Management (AIM) guidelines Show less