Oversees utilization review/ case management daily operations and workflow. Serves as a clinical resource and lends guidance to the Utilization Review and Case Manager staff in concurrent and retrospective review, resource utilization and denials, appeals management and case management.  Assist the Director of Case Management with implementation, maintenance and evaluation of an integrated case management program.

Requirements: Basic professional knowledge; equivalent to a Bachelor's degree; working knowledge of theory and practice within a specialized field; Maryland Registered Nurse License, CPR Certification, Case Management Certification Preferred.  Interqual and Milliman Utilization Review Criteria, Microsoft Office Suite, Basic computer skills, Cerner, Synquest, Standard Office Equipment.  Five to seven years of experience.