Utilization Review RN- Review perspective, concurrent and retro utilizing AI-Cortex, MCG, Inter-Qual. Daily interaction with MD's, CM, and all levels of staff in acute setting from remote position.

RN navigator -monitored and review documentation in EMR for OP setting for appropriate medical necessity and billing. Monitored and assited with Nuclear Stress Testing. Communication with several offices in this group to include PA's, MD's, medical assistants, nurses and non-clinical staff.

Reviewing medical charts via EMR for pertinent and appropriate medical necessity to meet guidelines for admission, discussed cases with Medical Director for denials, approvals, etc and appropriate documentation. Responsible for obtaining financial approval, auth's and other abilities of payment to facility. Seasoned with Medicare, Medicaid and all commercial and HMO's policies and guidelines for medical necessity requirements for admission and continued stays. Strong ability to communicate effectively telephonically, face to face and electronically.