identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team. KEY... quality issues to Medical Management leadership. Appropriately identifies potential cases for Care Management programs...
identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team. KEY... quality issues to Medical Management leadership. Appropriately identifies potential cases for Care Management programs...
, medical management, configuration, and appeals & grievances. Provide guidance as it relates to clinical appropriateness...JOB SUMMARY: The Medical Review Examiner Nurse is responsible for auditing provider and facility claims. Identifying...