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 a balance between individual clinical needs...
to clinical areas (e.g., high dollar and high quantity charge). Works with the PB and HB Denials teams to review and correct... Review Nurses, Clinical Documentation Improvement, and/or other relevant staff to correct conflicting coding, ambiguous...
and assures compliance with quality measures through concurrent and retrospective review, identification of deficiencies... to the septic patient. The Sepsis Coordinator provides clinical, professional expertise for patients, families, staff members...
to requests for services which includes a clinical record review and interviews with members, clinical staff, medical providers... services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical...
benefits Key Functions/Responsibilities: Provides clinical case review, consultation and oversight for all utilization... reviewers, including the contracted physicians Conducts clinical review of appeals and grievances in a fashion...
. · Meets monthly with Clinical Partner and Regional Dean to review clinical operations. · Is the primary contact for partner..., but not limited to: · Faculty and staff. · Clinical site liaison. · Clinical calendars and matrix. · Blended Learning...
. · Meets monthly with Clinical Partner and Regional Dean to review clinical operations. · Is the primary contact for partner..., but not limited to: · Faculty and staff. · Clinical site liaison. · Clinical calendars and matrix. · Blended Learning...
. · Meets monthly with Clinical Partner and Regional Dean to review clinical operations. · Is the primary contact for partner..., but not limited to: · Faculty and staff. · Clinical site liaison. · Clinical calendars and matrix. · Blended Learning...
and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity... Valley Hospital is in the top 5% of more than 4,500 hospitals nationwide for clinical performance. The hospital has achieved...
. · Meets monthly with Clinical Partner and Regional Dean to review clinical operations. · Is the primary contact for partner..., but not limited to: · Faculty and staff. · Clinical site liaison. · Clinical calendars and matrix. · Blended Learning...
, primarily responsible for facilitating the UM review process, ensuring timely and accurate submission of clinical documentation... Period 80 Shift Day Weekly Schedule Monday - Friday (8am - 4:30pm) Remote No Category Nurse Assistant Travel No Job Summary...
. · Meets monthly with Clinical Partner and Regional Dean to review clinical operations. · Is the primary contact for partner..., but not limited to: · Faculty and staff. · Clinical site liaison. · Clinical calendars and matrix. · Blended Learning...
. · Meets monthly with Clinical Partner and Regional Dean to review clinical operations. · Is the primary contact for partner..., but not limited to: · Faculty and staff. · Clinical site liaison. · Clinical calendars and matrix. · Blended Learning...
. · Meets monthly with Clinical Partner and Regional Dean to review clinical operations. · Is the primary contact for partner..., but not limited to: · Faculty and staff. · Clinical site liaison. · Clinical calendars and matrix. · Blended Learning...
members. Provides direction with implementation of care pathways. Responsible for concurrent review of charts to ensure... for peer review; responsible for appropriate and timely intervention and coordination with other members of the Care Management...
. · Meets monthly with Clinical Partner and Regional Dean to review clinical operations. · Is the primary contact for partner..., but not limited to: · Faculty and staff. · Clinical site liaison. · Clinical calendars and matrix. · Blended Learning...
. · Meets monthly with Clinical Partner and Regional Dean to review clinical operations. · Is the primary contact for partner..., but not limited to: · Faculty and staff. · Clinical site liaison. · Clinical calendars and matrix. · Blended Learning...
. · Meets monthly with Clinical Partner and Regional Dean to review clinical operations. · Is the primary contact for partner..., but not limited to: · Faculty and staff. · Clinical site liaison. · Clinical calendars and matrix. · Blended Learning...
, concurrent review, retrospective review, appeals, and clinical review processes, while working cross-functionally with providers... authorization, concurrent review, retrospective review, medical necessity determinations, and appeals. Ensure clinical decisions...
. · Meets monthly with Clinical Partner and Regional Dean to review clinical operations. · Is the primary contact for partner..., but not limited to: · Faculty and staff. · Clinical site liaison. · Clinical calendars and matrix. · Blended Learning...