utilization management position that has core responsibilities in the areas of inpatient concurrent review, pre and post service... utilization review, and collaboration with RN Case and disease managers. This director position will report to the Sr. Medical...
informed decisions. By serving as the link between patients and the appropriate health care personnel, the Clinical Review... Review target outcomes, and discharge plans with providers and families Complete all SNF concurrent reviews, updating...
Overview: To provide daily oversight, leadership, support, training and direction of both clinical and non-clinical... and clinical resource to colleagues, staff, members and others. Assists department leadership in identifying, monitoring...
facility CMs. Assists with concurrent and retrospective utilization review activities including denials and appeals. Works... with physicians to conduct peer review with payer medical director when indicated. Ensures clinical updates are provided...
by concurrent and retrospective denial of payments for services provided. Collaborates with physicians, Utilization Review RN.... Serves as a resource to all staff in areas of utilization review/management. Utilizes and analyzes current medical/clinical...
related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical... services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical...
underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care... Support and coaching of clinical documentation efforts Coordinating communication with physicians Must be able...
decisions. By serving as the link between patients and the appropriate health care personnel, the Clinical Review Coordinator... using clinical skills and utilizing CMS criteria upon admission to SNF and periodically through the patient stays Review...
decisions. By serving as the link between patients and the appropriate health care personnel, the Clinical Review Coordinator... using clinical skills and utilizing CMS criteria upon admission to SNF and periodically through the patient stays Review...
: Conducts the initial concurrent review process for all selected admissions. Clarifies documentation in the medical record...Overview: Performs inpatient chart review to determine appropriate DRG assignment and assures appropriate documentation...
: Associate's Degree: Related Field, Work Experience: Clinical bedside; CDI Responsibilities Conducts the initial concurrent...Job Description: Overview Performs inpatient chart review to determine appropriate DRG assignment and assures...
both clinical and operational success, this is the opportunity to make a lasting impact. Qualifications: Registered Nurse... Management/CDI, you’ll lead efforts to connect clinical excellence with financial strength. In this role, you’ll oversee...
and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity... is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic...
informed decisions. By serving as the link between patients and the appropriate health care personnel, the Clinical Review... in. Required Qualifications: Active, unrestricted registered clinical license required in state of hire - Registered Nurse, Physical Therapist...
informed decisions. By serving as the link between patients and the appropriate health care personnel, the Clinical Review... in. Required Qualifications: Active, unrestricted registered clinical license required in state of hire - Registered Nurse, Physical Therapist...
Review Committee), including performing and updating on medical/clinical case studies. Explores opportunities and makes...Job Category: Executive Leadership, Nursing - Registered Nurse Work Shift/Schedule: 8 Hr Morning - Afternoon...
areas. This position requires the ability to combine clinical/quality considerations with regulatory/financial/utilization... review demands to assure patients are receiving care in the appropriate setting and level of care. The position creates...
decisions. By serving as the link between patients and the appropriate health care personnel, the Clinical Review Coordinator... using clinical skills and utilizing CMS criteria upon admission to SNF and periodically through the patient stays Review...
decisions. By serving as the link between patients and the appropriate health care personnel, the Clinical Review Coordinator... using clinical skills and utilizing CMS criteria upon admission to SNF and periodically through the patient stays Review...
EDUCATION/ QUALIFICATIONS: · Graduate from an accredited school of Vocational nursing required · Licensed Vocational Nurse... will be required of all certified individuals. JOB KNOWLEDGE/EXPERIENCE: · Three years hospital nursing clinical experience preferred · Case...