of hiring if located within hospital Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used... clinical experience Current licensure as a Registered Nurse in the state of Washington (RN-WA) BLS required within 3 months...
Overview: The incumbent utilizes clinical judgement in providing utilization management services. The focus... services. Responsibilities: Conducts retrospective claims review, either in the aggregate or on an individual basis. Provides...
. Gathers information needed for Managed Care Utilization Reviews throughout the resident's stay and communicates this with the... are met, such as Physician certification and re-certification. Performs concurrent MDS review to assure appropriate RUGs category is achieved...
years of relevant experience Three to five years’ experience in care management, utilization review, home care... utilization, access, discharge planning, quality, service and efficiently across the continuum. This is an interventional role...
services (i.e. utilization review; care coordination; and/or discharge/transition planning). Responsible for managing a case... years of relevant experience Three to five years’ experience in care management, utilization review, home care...
and Federal or State regulations pertaining to their practice. Performs other duties as assigned, including utilization review... and appropriate utilization of inpatient resources using established evidence based guidelines/criteria. Collaborates with the...
as assigned, including utilization review as necessary. Qualifications Graduate of an accredited school of nursing. Minimum... to ensure progression of care and appropriate utilization of inpatient resources using established evidence based guidelines...
Utilization Review Professionals. MCG. ANCC Nursing Case Management. ACMA Case Management Administrator Certification... Utilization management review experience required. Excellent written, interpersonal communication & negotiation skills...
. Gathers information needed for Managed Care Utilization Reviews throughout the resident's stay and communicates this with the... are met, such as Physician certification and re-certification. Performs concurrent MDS review to assure appropriate RUGs category is achieved...
Utilization Review Professionals. MCG. ANCC Nursing Case Management. ACMA Case Management Administrator Certification... Utilization management review experience required. Excellent written, interpersonal communication & negotiation skills...
’ experience in care management, utilization review, home care and/or discharge planning. Preferred Registered Nurse (RN... planning of all hospitalized patients. 1. Identifies patients that need care management services (i.e. utilization review...
that supports excellence of care and achievement of optimal resource utilization. ESSENTIAL RESPONSIBILITIES Assumes role... data and chart review related to readmission. Knowledgeable of and complies with accreditation and regulatory requirements...
). Develops an effective working relationship with the Patient and Family Counselors/Social Workers and the Utilization Review... organizations, and recently was named in the 2023 Becker's Hospital Review “60 Hospitals and Health Systems with Great Oncology...
Workers and the Utilization Review Nurses to engage the patient/family to collaborate, advocate, and problem solve... accrediting organizations, and recently was named in the 2023 Becker's Hospital Review “60 Hospitals and Health Systems with Great...
and Federal or State regulations pertaining to their practice. Performs other duties as assigned, including utilization review... day Remote No Category Case Management and Social Work Responsibilities Weekender RN position- Additional...
as assigned, including utilization review as necessary. Qualifications: Graduate of an accredited school of nursing. Minimum... care, emergency services, surgery, maternity, cancer care, and diagnostic imaging. Responsibilities: Weekender RN...
Overview: Provides assistance with oversight during the daily operations of the outpatient review process... and Responsibilities ▪ Oversees daily operation of the outpatient review process. ▪ Provides direction and support, to staff concerning...
. Gathers information needed for Managed Care Utilization Reviews throughout the resident's stay and communicates this with the... are met, such as Physician certification and re-certification. Performs concurrent MDS review to assure appropriate RUGs category is achieved...
. Gathers information needed for Managed Care Utilization Reviews throughout the resident's stay and communicates this with the... are met, such as Physician certification and re-certification. Performs concurrent MDS review to assure appropriate RUGs category is achieved...
needs to promote appropriate utilization of services and improved quality of care. All case management/ coordination... for medication review and recommendations Reassess and update care plan with change in condition or care needs Support proactive...