Utilization Management Reviewer, RN - Rochester
1 month ago

Job Description:
This position coordinates integrates and monitors utilization of physical health medical healthcare services for members ensuring compliance with internal external standards set by regulatory accreditation entities Refers appropriate cases to Medical Director for review Refer to and work closely with Case Management to address member needs
- Performs pre-service concurrent post-service clinical reviews to determine appropriateness of services requested for diagnosis treatment of members medical health conditions applying established clinical review criteria guidelines medical policies contractual benefits as well as State Federal Mandates
Job description
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