Description Utilization Management Specialist JOB SUMMARY: Facilitates optimal reimbursement through accurate certification and complete chart documentation ensuring that the appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review when appropriate. Refers and consult with the multidisciplinary team to promote appropriate communication in the absence of definitive documentation and/or review criteria to support hospital stay. KEY RESPONSIBILITIES: Facilitates optimal reimbursement through certification and denial processes. Facilitates throughput of patients admitted
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Case Management Society of America 5034A Thoroughbred Lane Brentwood, TN 37027