of State and Federal regulatory requirements as it pertains to the utilization review process. Identifies dynamics of neglect... in-services staff meetings and formal educational settings in areas of utilization management. Demonstrate current knowledge...
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...
Our Client, a Health Insurance company, is looking for a Clinical Medical Review Nurse for their Baltimore, MD location.... Responsibilities: The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider...
as the unit-level nurse leader, serving as a member of MedStar Health’s entity-based Division of Nursing (DON) leadership... of the Division of Nursing and MedStar Health. Facilitates the cost-effective utilization of available resources (human...
accountable. Maintains ongoing communication with associates to review programs, discuss new developments, and exchange... associates, Medical Director, providers, other nurse leaders, and personnel from other departments for the purpose...
worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel. Identifies... clinical software system per Clinical Operation department's policy. Monitors utilization of all services for fraud waste...
families physicians quality review and insurance companies to obtain information and insurance verification to assure quality... patient flow and efficient staff utilization are also expected. Maintains a professional and courteous behavior to ensure...
About this Job: General Summary of Position Plans organizes coordinates and directs the Utilization Case Management... with subordinates to review programs provide feedback discuss new developments and exchange information. Contributes to the development...
, utilization review, informatics RN, Quality, DRG Validation and health IT preferred Knowledge of Medicare reimbursement system... degree, or physician assistant required Current Registered Nurse (RN) license required Certified Clinical Documentation...
associates accountable. Maintains ongoing communication with associates to review programs discuss new developments and exchange... associates Medical Director providers other nurse leaders and personnel from other departments for the purpose of coordinating...
, and consultations with nurse case managers and other associates to ensure the daily operations of the plan. Utilization review decisions... management, utilization review and other operations of the health plan. You will also conduct a daily review of current...
with utilization review team members on medical necessity determinations. Refers cases that need intervention. Communicates... RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the State of Maryland. Upon...