Employer Industry: Healthcare Services

Why Consider this Job Opportunity:
- Competitive pay up to the maximum mentioned in the job description
- Opportunities for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on patient care and satisfaction

What to Expect (Job Responsibilities):
- Conduct utilization review, quality review, and discharge planning for inpatient admissions
- Perform prospective, concurrent, and retrospective utilization review for all members requiring inpatient admission
- Coordinate case conferences involving multidisciplinary teams
- Attend scheduled rounds with physician reviewers to discuss clinical course and discharge planning
- Review monthly analysis of statistics and make adjustments based on findings

What is Required (Qualifications):
- Must have a thorough understanding of relevant state and Federal regulations
- Knowledgeable and compliant with regional personnel policies and procedures
- Participate in annual regional and departmental compliance training
- Access to protected health information (PHI) will be limited to the minimum necessary required to effectively perform the job

How to Stand Out (Preferred Qualifications):
- 0-2 years of experience in case management or utilization review in a healthcare setting

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