Description The Utilization Review/Management (UR/UM) Nurse position will work in in our UR/UM department. An overview of the work... requests for medical services to ensure they meet guidelines before treatment is provided. Concurrent Review: Evaluate...
about making a meaningful impact in both clinical and behavioral health? Our department stands out for its innovative, patient... and some holidays. General Summary Under general supervision, provides utilization review and denials management for an assigned...
, safety, and physician peer review activities for the hospital and outpatient departments. The CQO must: Drive quality... Develop a process to review and implement best practice to reduce variances and improve quality: Implement a comprehensive...
management or care coordination services. Performs concurrent review of patient treatment plans in accordance with the hospital... with primary, specialty and urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical...
about making a meaningful impact in both clinical and behavioral health? Our department stands out for its innovative, patient... and some holidays. General Summary Under general supervision, provides utilization review and denials management for an assigned...
. Job Responsibilities: Data Abstraction - 45% - Completes concurrent and retrospective data abstraction on burn registry cases... and correcting as needed using routine inter-rater reliability (IRR) review, report running, and data drilldowns. - Identifies data...
: Active, unrestricted registered clinical license required in state of hire - Registered Nurse, Physical Therapist... and facilitate informed decisions. By serving as the link between patients and the appropriate health care personnel, the Clinical...
family medicine and transitional year. Job Summary Provides thorough concurrent review of medical record clinical... to capture needed documentation. Able to conduct thorough medical record review on initial and extended-stay concurrent reviews...
: Active, unrestricted registered clinical license required in state of hire - Registered Nurse, Physical Therapist... and facilitate informed decisions. By serving as the link between patients and the appropriate health care personnel, the Clinical...
family medicine and transitional year. Job Summary Provides thorough concurrent review of medical record clinical... needed documentation. Able to conduct thorough medical record review on initial and extended-stay concurrent reviews on all selected...
as defined by the Nebraska Nurse Practice Act. Minimum of two (2) years recent clinical experience required. Prior care... review activities, including concurrent and retrospective reviews as required. Determines the medical necessity of request...
effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the... seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost...
and coordinates transition to next level of case management or care coordination services. Performs concurrent review of patient... in Case Management - Preferred 7 years as a Registered Nurse (RN) - Preferred Other Experience in an outpatient clinical...
and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity... to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic...
effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the... seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost...
needed. Utilization Management: When assigned UM tasks, the UM/CM must: Perform pre-authorization, concurrent, and discharge review... of a team to provide referral, authorization, medical review, and/or case management services to providers and Health Plan...
and continued hospital stay applying appropriate clinical criteria. Performs admission review within 24 hours or the first business... and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment. Accountable...
of clinical criteria documentation requirements used to successfully substantiate code assignments Perform clinical coding review... to ensure accuracy of medical coding and utilize clinical expertise and judgment to determine correct coding and billing...
of clinical criteria documentation requirements used to successfully substantiate code assignments Perform clinical coding review... to ensure accuracy of medical coding and utilize clinical expertise and judgment to determine correct coding and billing...
and continued hospital stay applying appropriate clinical criteria. Performs admission review within 24 hours or the first business... and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment. Accountable...