Charleston, WV11 days ago
Bachelor's Degree (Required) Education: or Bachelor Degree - Related Degree Experience: 5 - 7 Years - Combined Experience to Include at Least 5 Years Professional Nursing, and Applicable Experience in Case Management, and/or Utilization Review, Supervisory/Management of Case Management and/or Utilization Management Team , Minimum of 1 year in quality assurance/quality improvement and Experience with MCG and/or InterQual, and other evidenced-based guidelines for utilization management and case coordination Education: or Bachelor Degree - Related Degree Experience: 5 - 7 Years - Combined Experience to Include at Least 5 Years Professional Nursing, and Applicable Experience in Case Management, and/or Utilization Review, Supervisory/Management of Case Management and/or Utilization Management Team , Minimum of 1 year in quality assurance/quality improvement and Experience with MCG and/or InterQual, and other evidenced-based guidelines for utilization management and case coordination. Design and analysis of utilization opportunities, development of strategies to decrease utilization, development of staff to coordinate patient admissions and discharges, collaboration with physicians to change practice patterns, and negotiation with payor for certified days of care.