. Concurrent Clinical review with payors. Document in the electronic system daily in real time. Admission audit. Ensures...: Neuropsychiatric Hospitals is looking for a Utilization Review Nurse (RN) to coordinate patients’ services across the continuum of care...
, staff meetings &/or utilization review committee meetings; assists in development of clinical practice manual for assigned...What you’ll do at OhioMHAS: Coordinates activities & functions of utilization review program to assure quality care...
Job Title: Utilization Review Nurse Job Description The Utilization Management Nurse (UMN) collaborates closely... as assigned. Essential Skills Clinical review Utilization review Utilization management InterQual Milliman Commercial...
-based settings Experience with case management, utilization review, discharge planning, concurrent review and/or risk... at Home program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical...
Primary Responsibilities Perform prospective, concurrent, and retrospective utilization reviews and first level... determination approvals for members using evidenced based guidelines, policies and nationally recognized clinical criteria...
concurrent reviews Review the need for denial of stay with assigned clinical treatment team when patient no longer meets acute... clinical treatment team and third-party payers to promote appropriate treatment for psychiatric illness...
Job Summary: As a Utilization Management Nurse/Social Worker, you'll play a crucial role in our multidisciplinary.... Proficient in Utilization Review processes, you'll maintain effective procedures to meet regulatory and reimbursement...
Description : The Professional Review Nurse provides analysis of medical services to determine appropriateness....U., C.C.U., E.R., and orthopedics preferred Prospective, concurrent and retrospective utilization review experience...
. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior.... In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial and concurrent...
Our Client, a Health Insurance company, is looking for a Registered Nurse-Review Analys for their Detroit, MI/Hybrid... location. Responsibilities: Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory...
Job Category: Revenue Cycle Job Description: Cottage Health seeks a Utilization Review Manager, Registered Nurse... for their Clinical Denials and Appeals department responsible for the overall management of utilization review processes and clinical...
reliability test for Utilization Review product(s) used Proficient in application of clinical guidelines (MCG/InterQual... Employment Type Full Time Department Utilization Review Hours/Pay Period 80 Shift Day Weekly Schedule Monday- Friday (start time...
test for Utilization Review product(s) used Proficient in application of clinical guidelines (MCG/InterQual) preferred... as part of our mission, vision, and values. Responsibilities: The Utilization Review RN is responsible for the review...
to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. Conducts concurrent... to establish the appropriate level of care using Interqual criteria. Integrates clinical knowledge with billing knowledge...
SUMMARY: The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate use.... Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity...
Works under the supervision of the Director of Care Management. Reviews the medical record on a concurrent basis... multidisciplinary team to improve clinical care, customer satisfaction, organizational and financial outcomes. Serves as a clinical...
OR HAVE WASHINGTON STATE BEHAVIORAL HEALTH LICENSURE*** Position Purpose: Performs a clinical review and assesses care related... Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs...
Review Coordinator This position is responsible for monitoring the treatment activities offered to the patient, interfacing... professionals for continuity of care. Complete concurrent reviews for mental health and dual diagnosis patients for both inpatient...
Review Coordinator This position is responsible for monitoring the treatment activities offered to the patient, interfacing... professionals for continuity of care. Complete concurrent reviews for mental health and dual diagnosis patients for both inpatient...
clinical model, integrating services from precertification, inpatient concurrent review, discharge planning, care management... management, prior authorization, utilization management/review or concurrent review 1+ years PACM/DCM experience Experience...
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