review audits as directed. Supports the Capital Health Utilization Committee with analysis of clinical outcomes data.... Reviews and updates denial status from pending and open denials (concurrent reconsideration and peer-to-peer review...
Overview: The Quality Documentation Specialist is responsible for concurrent and retrospective review of medical record... be required at acute clinical care facilities. Licensure: Registered Nurse Required Education: Bachelor's Degree Nursing Preferred...
benefits and coverage may be made. Provides clinical information requested by providers as part of the concurrent appeal... utilization of resources for maximum patient outcomes. Partners with the Charge Nurse, Social Worker, physician and other members...
effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the... seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost...
your best work. Job Summary: Evaluates medical record documentation for evidence of clinical information to support charges... applicable. Associates clinical and coding information to national and local coverage determination. Reviews the medical record...
as determined by manager. Location presence may be required at acute clinical care facilities. Licensure Registered Nurse...Job Description: Overview The Quality Documentation Specialist is responsible for concurrent and retrospective...
/Licensed Practical Nurse) to join our team. The Medical Case Manager (LVN/LPN) will be working within Concurrent Review... established clinical protocols to determine medical necessity. Screens requests for the Medical Director's review, gathers...
and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record... a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical...
Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises... authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines...
Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health...Job Description: Your Role The Behavioral Health Utilization Management team performs prospective, concurrent...
effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the... seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost...
Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health...Your Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective...
, implementation and evaluation of Partnership’s clinical case management services. Collaborates with Supervisor(s) to oversee the..., and clinical management of assigned staff in accordance with industry best practices which includes training oversight, the...
Clinical and Quality officer to develop, evaluate, review, revise and implement policies and procedures. Monitors key...Highly organized, and experienced hospice and home health leader who is a Registered Nurse. This professional...
to next level of case management or care coordination services. Performs concurrent review of patient treatment plans in accordance... medical group with primary, specialty and urgent care services, a cancer care network, outpatient surgery centers, clinical...
to next level of case management or care coordination services. Performs concurrent review of patient treatment plans in accordance..., clinical research, medical education, a foundation, an accountable care organization, community services...
clinical documentation in the medical record. Performs retrospective reviews in Hospice, Mortality, Clinical Validity, Risk... directly with Clinical Documentation Integrity (CDI) leadership, but has the ability to function independently utilizing...
effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the... seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost...
effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the... seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost...
for concurrent denials, including nurse or provider peer to peer. Performs patient care, where competent and assists in coordination... to improve patient care to achieve optimal clinical and financial outcomes. Job Duties and Responsibilities Direct supervisor...