but not limited to: Access Authorization and pre-certification, utilization review and denial management, Care Coordination... of utilization criteria, appeal and review process, and case management system documentation. Develop staff schedule and revises...
benefits. Works on reviews that are routine having limited or no previous medical review experience requiring guidance... if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review...
, such as equipment maintenance, scheduling, supply utilization monitoring etc. Leads NEST based peer review processes. Leads.... Under the direction of the Nurse Manager, the RN will work in conjunction with the bedside team at all UMMS L&D units to provide...