The incumbent utilizes clinical judgement in providing utilization management services. The focus is to provide high quality, cost-effective care which will enable patients to achieve maximum medical improvement while receiving care deemed medically necessary. Assists in determining appropriateness, quality and medical necessity of treatment plans using pre-established guidelines. This position may be assigned cases in long-term care and ancillary, DME or medical services.

The Training and Education Coordinator will design the training program for the Utilization Management (UM) Department’s data platforms, medical necessity software, and department policies and procedures in consultation with UM Supervisors and Managers