required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare teams... utilization of services Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided...
: Registered Nurse - NJ Knowledge and Skills: Three years of clinical nursing or two years quality management, utilization review..., to the UR physician advisor for review and determination. Gathers clinical information to conduct continued stay utilization...
JOB DESCRIPTION SUMMARY Reports to the Nurse Supervisor and assists in the process of health management and utilization review (UR). The...Johnson Service Group (JSG) is seeking a Bilingual Utilization Review Coordinator. This position is remote - MUST WORK...
Franciscan Health Michigan City Campus 3500 Franciscan Way Michigan City, Indiana 46360 The Utilization Review... and utilization. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the...
. This is a Salaried position. Overview POSITION SUMMARY: The Utilization Management and Review Specialist (UMR Specialist) evaluates... admission status of each patient. In addition the UMR Specialist will identify utilization issues involving under or over...
for inpatient admission or observation in Community Hospitals and UTMB-TDCJ Hospital. Performs utilization review procedures... as needed. Participates in research activities/projects Provides assistance regarding clinical issues to non-nursing utilization review staff...
Review Manager RN to join our Utilization Review team. The Utilization Review Manager RN oversees and directs all operations... of the Utilization Review department. Ensures the effective use and monitoring of healthcare resources to support positive...
school of nursing and a current state Registered Nurse license. Minimum 3 years RN Utilization Manager working for a Health... Plan. At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals. Current BCLS...
. Minimum 3 years RN Utilization Manager working for a Health Plan. At least 3 years of experience in utilization review... and insure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive review...
solutions. Schedule: Full-Time 40 hours per week What You'll Do The Utilization Review Coordinator provides utilization... review to assure patients are admitted to the hospital in the correct status according to applied criteria. They work closely...
a thorough medical record review and knowledge of federal and evidence-based guidelines, including CMS Conditions... utilization management to patients, families, and other members of the care team as needed. Maintains current knowledge of health...
of mental health and substance abuse utilization review process preferred. Experience working with providers and healthcare... perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health...
required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare teams... BH member data to improve quality and appropriate utilization of services Interacts with BH healthcare providers...
Responsible for utilization review work for emergency admissions and continued stay reviews. Responsibilities... Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources...
, decisions, communications, and patient education in the EMR Participates in performance improvement initiatives, utilization... review, and data collection efforts for administrative reporting Conducts 48-hour post-discharge follow-up calls...
experience in chart analysis and in the utilization review field. Excellent oral and written communication skills... provides precertification and verification of benefits for incoming patients. Coordinates the utilization management functions...
experience in chart analysis and in the utilization review field. Excellent oral and written communication skills... provides precertification and verification of benefits for incoming patients. Coordinates the utilization management functions...
Job Summary You will review patient cases for medical necessity and establish service suitability. You'll educate the healthcare...'s health plan and the provider's care coordination departments. Your expertise is needed to review medical necessity. Working...
solutions. Schedule: Part-Time 30 hours per week What You'll Do The Utilization Review Coordinator provides utilization... review to assure patients are admitted to the hospital in the correct status according to applied criteria. They work closely...
by regulatory agencies. Assists with utilization review and blood administration education and auditing. Observes and critique.... Assists with utilization review and blood administration education and auditing. Observes and critique of blood transfusion...