Utilization Review RN

من الإعلان الأصلي

US Accountabilities Medical necessity reviews: Conduct clinical reviews of inpatient admissions, observation stays, and continued hospital stays using approved medical necessity criteria to determine appropriate patient status and level of care. Utilization management: Identify potential overutilization or underutilization of healthcare services by evaluating diagnoses, costs, complications, and clinical indicators. Refer cases to physician advisors when necessary. Clinical documentation and coordination: Collaborate with physicians, in-house care managers, and interdisciplinary teams to…