and other stakeholders regarding review outcomes. Collaborates with facility RN Care Coordinators to ensure progression of care. Engages... Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage...
that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information... for utilization review. Apply clinical reasoning to determine the suitable evidence-based guidelines. Foster efficient and high...
Description : The PPI Clinical Review Manager is responsible for the overall aspects of the PPI Clinical Review... & RESPONSIBILITIES: Responsible for managing the daily file flow coming into Clinical Review while maintaining awareness of potential...
you want to be treated. Position Summary: Performs medical record review for severity of illness and intensity of service...; liaison function with external review agencies to ensure compliance with regulations affecting financial reimbursement...
Job Description JOB TITLE Utilization Review Nurse REPORTS TO Utilization Review, Manager STATUS FT, Exempt WAGE RANGE..., and alignment with evidence-based guidelines and benefit coverage. Conduct prior authorization and HRS flex reviews, applying...
for medical necessity and services provided. Facilitate peer review calls between facility and external organizations. Initiate...: LPN Diploma with a current NC Nursing license OR Associate’s Degree in Nursing (RN) with current NC Nursing license...
Social workers in coordinating post-discharge care. Clinical Documentation Specialists review documentation to ensure... intervention to facilitate patient care in an optimal timeline. Oversees utilization review process including education, support...
Review RN will report to the Manager, Post Service. In this role you will perform accurate and timely clinical review of post... plans used to complete review decisions Qualifications: Your Knowledge and Experience Requires a current CA RN...
Work From Home Work From Home Work From Home, Indiana 46544 The Utilization Review Coordinator performs admission... in nursing/patient care required Bachelor's Degree in nursing/patient care preferred Registered Nurse (RN - Indiana...
review and quality assurance experience. Education and Licensure: The MR Manager shall have a current Registered Nurse (RN.... Our mission is to empower our employees to do great things for the benefit of those that needs us most. The J29 mission supports...
Nursing experience in Acute Care hospital and/or care management or utilization review experience in any setting. Current WA... or Multistate RN License Current BLS Preferred Qualifications Bachelor’s degree in Nursing Current Care Manager Certification...
Review Specialist - Ambulatory Surgical Centers. This position can be remote from anywhere in the Continental U.S with travel... accreditation supervisory review work, both pre-survey and post-survey, within agreed timescales, as required by CMS...
available resources to promote quality, cost effective outcomes. Performs medical or behavioral review/authorization process. Ensures... coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up...
Review and the Nurse Case Managers including utilization review and case management functions. Ensure compliance of MPN... & liability. What You'll Do Manage Bill Review and Managed Care units. Review and report on monthly financials for case...
of Case Management/Utilization Review, the UR/Case Manager supports members by coordinating services, tracking care progress... health services Collaborate with licensed professionals to determine medical necessity and benefit coverage Coordinate...
as defined by review methodologies specific to the type of review. This involves completing medical records review, accurately... & RESPONSIBILITIES: The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding...
and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the... contract for which review services are being provided. This involves completing medical records review, accurately documenting...
criteria to determine the medical necessity of an inpatient status. The RN Review Analyst will perform admission approvals...Our Client, a Health Insurance company, is looking for a Registered Nurse-Review Analys for their Detroit, MI location...
and contributing to accreditation survey process. JOB REQUIREMENTS: Registered Nurse (RN) with unrestricted license in state.... Learn more about our benefit offerings by visiting . The compensation offered will vary depending on your job-related...
Position Details Pediatric Clinical Supervisor (RN) Full Time with Benefits Pediatric Extended Care Center (PECC) Work... with staff assignments to our classrooms, followed by quality assurance nursing documentation review. From there, you will spend...