, 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...
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...
and oversight of all quality-related programs and initiatives across the facility, including Utilization Review (UR), Performance... requirements Oversee utilization review processes to ensure efficient and medically necessary use of healthcare resources Develop...
assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care... Responsibilities: Utilization Management Utilizes Payer specific screening tools as a resource to assist in the determination...
Manager provides direct supervision to the RN Case Managers, Utilization Review Nurses and utilization review LVNs... positive partnership between Social Workers, Case Managers, Utilization Review nurses, Discharge Planning Coordinators and the...
. AS THE UTILIZATION REVIEW - REGISTERED NURSE, you'll be responsible for the comprehensive, interdisciplinary coordination... preferred Case management / utilization review experience preferred Literate in software and information systems...
Reports to the Manager/Utilization Review and Case Management. Is responsible for assessing, planning, coordinating... improvements in the quality of utilization review practice and standards. Serves as a resource to staff. Assists with steps...
relief. Shift Times: 5 day, 8 hour shifts POSITION SUMMARY The Utilization Review (UR) nurse performs medical necessity... to insurance reimbursement in appropriate reviews. The UR Nurse utilizes advanced clinical skills to facilitate the provision...
We are recruiting for a motivated Supervisor, Nursing Utilization Review to join our team! We are here for life.... Department Hospital Care Mgmt Job Summary The Supervisor, Nursing Utilization Review is responsible for the clinical...
and Attending) based upon thorough medical record review and knowledge of federal and evidence-based guidelines, including CMS.... Communicates effectively and professionally regarding modality. Provides education regarding utilization management to patients...
SUMMARY: We are currently seeking a Utilization Review Manager to join our Transitional Care Team. This is a full... review functions. Oversees daily operations, which include supervising staff performing utilization management activities...
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...
Utilization Review RN - Per Diem* *IMPORTANT NOTE: In lieu of benefits due to "per diem" status, 15% will be added...; OR an equivalent combination of education and experience AND (2) two years’ experience Utilization Review. Certificate Preferred...
Nursing experience in Acute Care hospital and/or care management or utilization review experience in any setting. Current WA... and utilization of services for acute care and post-acute skilled patients. The Care Manager will work collaboratively...
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...
and requirements along with the precertification/concurrent review monitoring requirements for the various utilization management... guidelines for Utilization Review are followed. Evaluates and initiates action on QIP correspondence i.e., pending...
in a managed care organization (i.e. HMO), two (2) years of which must have included experience as a Utilization Review Nurse... Department is seeking to fill one (1) Utilization Review Manager position in Contra Costa Health Plan, located in Martinez...
Description : Utilization Management Specialist Seven Hills Hospital brings a world of compassion, hope... professionals. We are presently looking for a Full Time Utilization Management Specialist who will be responsible for: The...