denies payment for days during concurrent review, contact the attending with this information. The attending can... for concurrent appeal of the denial Qualifications Education: Registered professional nurse licensed to practice in the state...
Functions: Utilization Management- Utilization Review and Care Transitions & Coordination Providing clinical information... and/or as required by insurer, (concurrent and retro) for medical and/or psychiatric appropriateness according to Hospital's approved criteria...
·Excellent benefits Key Functions/Responsibilities: ·Provides clinical case review, consultation and oversight... for all physician reviewers, including the contracted physicians ·Conducts clinical review of appeals and grievances in a fashion...
record monitoring Coordinates communication with third party payers, external review agencies and the Utilization Committee... Initiate and monitor clinical care guidelines and analyze positive and negative variances Ensure continuity of care through...
through the continuum of care. Responsible for financial, clinical, and discharge planning evaluation for each assigned... for efficient and effective outcomes as related to quality, clinical and cost areas. Responsibilities: Manages an assigned caseload...
including: Concurrent review of all patients to validate that the appropriate patient status is assigned upon admission... in InterQual and/or MCG competency testing. 8. Perform telephonic, and if appropriate, on-site initial/concurrent review...
Job Description: Responsibilities Registered Nurse RN Joint Replacemtn Institute Full-Time Days St. Mary... plan of care of nurse action, implementation of the plan of care and the evaluation of the process, by use of the nursing...
Job Description: Responsibilities Registered Nurse RN Joint Replacemtn Institute Full-Time Days St. Mary... plan of care of nurse action, implementation of the plan of care and the evaluation of the process, by use of the nursing...
Position Purpose A clinical position that works within a collaborative process to assess, plan, implement, coordinate... appropriate utilization of care and services, and cost effective outcomes. The Case Manager is responsible for the review of the...
. Duties/Responsibilities: A. Utilization Management Performs review of anticipated admissions utilizing InterQual criteria... of care based on initial assessment and concurrent collaboration with other care givers, external service organizations...
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 progress in meeting treatment goals. The QP assists the clinical team with arranging and providing psychoeducation as indicated... provision of concrete services to the child/adolescent/family. Complete all non-clinical intake paperwork for case management...
Job Description: Responsibilities Registered Nurse RN Joint Replacemtn Institute Full-Time Days St. Mary... plan of care of nurse action, implementation of the plan of care and the evaluation of the process, by use of the nursing...
Job Description: Responsibilities Registered Nurse RN Joint Replacemtn Institute Full-Time Days St. Mary... plan of care of nurse action, implementation of the plan of care and the evaluation of the process, by use of the nursing...
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...
on admission and concurrent basis. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan..., and third-party payer requirements related to discharge planning and mandated reporting. Review admissions, level of care...
as specified by Insurance / State & Federal regulation. Enters concurrent review information for Review Nurses in Allscripts... Mail - Sort, identifies location and distribute to appropriate departments Monitors Concurrent Nurse denial phone calls...
process. Perform concurrent and retrospective review of medical records to abstract clinical data on stroke patients. Provide..., is responsible for the administrative and clinical support of the hospital’s Stroke Center. Administer and maintain the standards...
policies and clinical guidelines within scope of licensure. These reviews may require in-depth review; however, any deviation... years of clinical experience and/or utilization review experience. Current active, valid and unrestricted RN license...