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Job Description The Utilization Review RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization review and management. This position includes monitoring patient charts and utilization of health care services. Collaborates and communicates with physicians, Care Coordinators, Social Workers and other members of the multidisciplinary and revenue cycle teams.Completes initial and concurrent reviews; identifies appropriate level of service and length of stay, using clinical guidelines (InterQual). Complies with CMS regulation regarding utilization review/management. Obtains and manages insurance authorizations and proactively works denials to help mitigate
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