Skills:
Case management, Utilization Management (Inpatient, Outpatient, Homecare Services, Pre-Certification, and Concurrent Review. ) Utilization review for Managed Care HMOs, Medicare, Medicaid, Tricare-Military and Department of Defense Negotiation of LOA for out-of-network providers. EMMA, Paradigm/Diamond, Sidewinder, Interaqual. Casetrakker , Interaction Client, Cisco systems Knowledge of URAC & NCQA standards