authorizations, and confirms post hospital care benefits. Performs concurrent review within time frames to obtain continued stay... with a current Indiana license to practice as a Registered Nurse, a Bachelor's (BSW) or Master's (MSW) of Social Work...
ability to use multiple systems and clinical applications to collect, evaluate, and enter transplant and living donor data to ensure... quality assurance and performance improvement (QAPI) initiatives. 4)Performs retrospective and/or concurrent patient medical...
knowledge of organizational or state-wide trends that affect utilization trends and the impact that concurrent review and a high... services and renders clinical determinations in accordance with healthcare policies as well as applicable state and federal...
transitions of care for a defined patient population. The Utilization Management Nurse will perform utilization review every day... records documentation communication with physicians and physician's advisors. The UM nurse will gather clinical information...
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...
)Performs retrospective and/or concurrent patient medical record reviews/audits to abstract clinical data for program QAPI... and UNOS reporting requirements. 1)Demonstrates the ability to use multiple systems and clinical applications to collect, evaluate...
and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity... is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic...
in discharge. Documents all Avoidable Days in CANOPY system. Performs clinical review on admission and/or continued stay using.... The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization management...
Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages..., providers, employer and community groups, and members as needed. Utilizes clinical knowledge and experience to support value...
with demonstration, practice, remediation, reinforcement, review, skill and clinical make-up days, and simulation in skills lab. Receive... Nurse Licensure Compact (NLC) Required Experience Three (3) years of clinical nursing experience, including at least two...
patients to be admitted for discharge needs. Concurrent review of patients clinical information for efficiency and correct... to deliver world-class care. Here, you'll work alongside some of the best clinical talent in the nation leading the way...
patients to be admitted for discharge needs. Concurrent review of patients clinical information for efficiency and correct... to deliver world-class care. Here, you'll work alongside some of the best clinical talent in the nation leading the way...
review per Kaiser policy Ensures timely communication of clinical data to various payers to support admission, level of care... collaboratively with the interdisciplinary team to provide care coordination for patients under the direction of a Registered Nurse...
with demonstration, practice, remediation, reinforcement, review, skill and clinical make-up days, and simulation in skills lab. Receive... Nurse Licensure Compact (NLC) Required Experience Three (3) years of clinical nursing experience, including at least two...
concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization... programs. Maintain contact with the inpatient facility utilization review personnel to assure appropriateness of continued...
. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity criteria..., and Whole Health markets. Possesses clinical knowledge, understands best practices and continuous learning skills, reviews...
concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization... programs. Maintain contact with the inpatient facility utilization review personnel to assure appropriateness of continued...
concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization... programs. Maintain contact with the inpatient facility utilization review personnel to assure appropriateness of continued...
experience or equivalent combination of clinical and educator experience. (Can be concurrent) Knowledge of medical terminology... and medical review by use of written advisories, reports, letters, and telephone contacts. Document all provider contacts...
. Concurrent review of patients clinical information for efficiency and correct level of care and admission status. Interface... to deliver world-class care. Here, you'll work alongside some of the best clinical talent in the nation leading the way...