PURPOSE STATEMENT: Monitor utilization of services and optimize reimbursement for the facility while maximizing use... companies for inpatient treatment and continue to obtain authorizations for duration of patient stay. Evaluate the utilization...
of community investment What You Will Do Provide strategic and operational leadership for Case Management, Utilization Review... of: Prospective payment systems Managed care Utilization review Discharge planning CDI and mid-revenue cycle Payor relations...
seeking an experienced Utilization Review Nurse who will serve as an integral contributor in the delivery of AwareUM...ABOUT THIS POSITION The Clinical Product Consultant for Utilization Management is a member of the Customer Success...
oriented atmosphere. Responsibilities Reviews medical records and attends treatment team meetings to review utilization... is looking for a Utilization Management Reviewer to monitor the utilization of clinical services provided at Mental Health Resource Center (MHRC...
, retrospective review, bed status management, resource utilization management, regulatory compliance, and related denial management... here. This position is responsible for performing the daily operations of the Utilization Management program at AnMed within the Care...
anywhere in the United States. This position does require an Oregon RN or LPN license. The work schedule for the position is Monday... and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care Coordinates...
: As a Medical Review Specialist V (Medical Reviewer V), you will review and analyze Medicare claims sampled by the Department... of Justice, using associated medical records, to make payment determinations based on coverage, coding and utilization...
As a Medical Review Specialist V (Medical Reviewer V), you will review and analyze Medicare claims sampled by the... Department of Justice, using associated medical records, to make payment determinations based on coverage, coding and utilization...
***This is a fully remote role but candidates must have a valid RN license in Illinois*** Position Purpose: Care Review Clinician works... with the Utilization Management team primarily responsible for medical necessity/utilization review aimed at providing members...
Residential Review, and other compliance reviews). Analyzes and reports significant utilization trends, patterns, and impact.... What you will do: We are looking for a SENIOR DIRECTOR OF MEDICAL REVIEW who can help shape our vision and support our mission. Here is what the position will look...
plan clinical operations (for example utilization review, quality improvement, clinical claims review). Experience...JOB SUMMARY: The Medical Review Examiner Nurse is responsible for auditing provider and facility claims. Identifying...
management, discharge planning or utilization review experience. Licenses/Certifications: RN - Registered Nurse - State.... We are in search of a highly motivated candidate to join our talented Team. Job Title: Clinical Medical Review Nurse. Location...
. Settings include inpatient, outpatient, in-state, out-of state and out-of country. Document clinical case summary and review... outcome of each review appropriately to meet regulatory and program requirements. Review various types of services, including...
including utilization review and case management functions. Ensure compliance of MPN with our business partner, design, develop... of the position will be to differentiate the PRIME program in the marketplace; manage bill review and the nurse case managers...
managers including utilization review and case management functions. Ensure compliance of MPN with our business partner, design... functions of the position will be to differentiate the PRIME program in the marketplace; manage bill review and the nurse case...
Job Description: This position will be remote role for Nurses in Michigan Should have a valid MI RN License... Should Have utilization management experience. Should have experience completing post-acute reviews for the inpatient rehab, skilled nursing...
of functions of case management, utilization review and management and discharge planning. Why join us We believe... to others. As a Case Manager (RN, OT, SLP, PT) joining our team, you're embracing a vital mission dedicated to making communities healthier...
’s plan of care and review on an ongoing basis Provide ongoing coaching to drive effective utilization of established... What You Will Bring: Must hold an active Registered Nurse (RN) License and/or be a Licensed Social Worker (LSW/LISW) in the state...
plan conferences. Monitor and guide the completion of PPS and OBRA assessments. Manage the Utilization Review (UR...Description : MDS Coordinator (RN) Status: Full-Time (on-site) Wage: $110,000 - $131,000 annually - depending...
Medical Records Coordinator Opportunity at University RN The Medical Records Coordinator is responsible for the... successful utilization of the electronic medical record (EMR). The Medical Records Coordinator will work with physicians, office staff...