to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial... interventions and utilization review activity per department and medical center standards in a timely manner. Performs and documents...
with clinical information for denial reversals Perform utilization review in accordance with UM Plan to include concurrent/retro...Registered Nurse - Case Management Travel Job in Layton, Utah Registered Nurse - Case Management Travel...
and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity... to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic...
initial and concurrent utilization review to ensure certification/approval of in-patient and post discharge services. 5... classification. 1. Functions as a key point of contact between clinical case management staff, admissions and payors. Documents...
industry accepted processes for achieving optimal patient, clinical, and operational outcomes timely, coordinated, and in cost... and available resources. The Acute Case Manager monitors clinical approaches and make recommendations for alternate levels of care. The Acute...
, concurrent or retrospective basis in order to maximize revenue for TriHealth. This includes analysis of clinical information... years of hire Registered Nurse Current Ohio licensure 5-7 years experience Clinical in Nursing hospital based...
initial and concurrent utilization review to ensure certification/approval of in-patient and post discharge services. 5... classification. 1. Functions as a key point of contact between clinical case management staff, admissions and payors. Documents...
related to supported technology. Manage utilization review, translation of foreign claims, coordination of benefits (COB.... ESSENTIAL RESPONSIBILITIES Coordinates the clinical care with the patient, family, physician(s), and other members of the...
, clinical psychiatric setting, disease management, hospice/home health or community/public health. Highly Preferred... resources, and assumes a collaborative role with all members of the healthcare team to achieve optimal clinical and resource...
, develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels..., admission, and concurrent utilization reviews to determine appropriate levels of care and readiness for discharge. Escalates...
initial and concurrent utilization review to ensure certification/approval of in-patient and post discharge services. 5... classification. 1. Functions as a key point of contact between clinical case management staff, admissions and payors. Documents...
their needs, coordinating care, communicating with health plans, including concurrent review to determine the appropriateness... as appropriate. Coordinates with Nurse Practitioners and ISP Hospitalists assigned to the SNFâs for continued review and follow up...
for appropriateness of admission and continued hospital stay applying appropriate clinical criteria. Performs admission review within 24... and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment. Accountable...
applying appropriate clinical criteria. Performs admission review within 24 hours or the first business day. Refers cases... and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment. Accountable...
. Provides direction for concurrent modification to clinical documentation to ensure appropriate coding for reimbursement... provider. Oversees Reviews: Conducts concurrent and retrospective review of the medical records to increase the accuracy...
.  A utilization nurse completes no less than 20 initial clinical reviews daily.  Responsibilities also includes...: â¢Â   Completing 100% clinical reviews for managed care, Medicare and Medicaid admissions â¢Â   Completing concurrent...
(UM) Principal Nurse is responsible for concurrent utilization management activities to a defined MHS Licensed Facility. The licensed... facility Principal UM Nurse is a link between the patient, health care team, organization leadership, and payers during the...
; actively participate in the concurrent review process and communicate/intervene with third party payors to ensure reimbursement... Premium Paid Vacation & Holidays Clinical Ladder Certification Pay Shift Differentials Relocation Assistance Benefits...
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...
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...