you. Description: Job Summary: Under direction of Registered Nurse and medical orders of the Practitioner, provides direct and indirect nursing... for authorization by practitioner and may accept verbal orders per policy; observes, collects, and documents new information on patient...
you. Description: Job Summary: Under direction of Registered Nurse and medical orders of the Practitioner, provides direct and indirect nursing...; reviews patients needs; identifies and prepares orders for needs of patient for authorization by practitioner and may accept...
professional licensure required as Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW... preferred. Prefer prior experience in case management, utilization review, or discharge planning....
: Manages Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care... within utilization management. Manages prior authorization, concurrent review, and retrospective clinical review team and ensures...
to UM and/or prior authorization processes with applicable. Completes activities relating to determination of medical necessity..., authorization, continued stay review including diagnosis and procedural coding for working diagnosis related group (DRG) assignments...
/DESIGNATIONS/CERTIFICATIONS: Licensure, as required for the area of clinical specialty, i.e., RN license, CAC or other clinical... are required: Review complex referrals with administrator-on-call and/or physician Obtain physician orders Accept nurse-to-nurse report...
resources Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization... Licenses/Certification Healthcare professional licensure required as Registered Nurse, or Licensed Clinical Social Worker...
Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations... continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies...
required as Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations... continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies...
required. Minimum of two (2) years of nursing experience working in a clinical setting Prior teaching experience. Experientially... including RN to BSN, RN to MSN, a Master of Science in Nursing (MSN) with six Specialty Tracks, and a Doctor of Nursing Practice...
required. Minimum of two (2) years of nursing experience working in a clinical setting Prior teaching experience. Experientially... including RN to BSN, RN to MSN, a Master of Science in Nursing (MSN) with six Specialty Tracks, and a Doctor of Nursing Practice...
. CERTIFICATES, LICENSES, REGISTRATIONS Active license as a LMFT, LCSW, LPC, THW, psychiatric nurse practitioner, RN, or clinical... in the community. Manages BH case management and BH utilization management including prior authorizations. Leads the...
appropriate clinical documentation for review and to meet inpatient criteria by the Interqual Guidelines. The Case Managers... encompasses a variety of tasks related to performing the following: integrated concurrent review for utilization; quality and risk...
licensure required as Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW... preferred. Prefer prior experience in case management, utilization review, or discharge planning....
Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health... unrestricted CA license (LCSW, LMFT, LPCC, Licensed Psychologist, or Registered Nurse (RN) with Behavioral Health experience...
setting. California Registered Nurse (RN) - CA Board of Registered Nursing Preferred Qualifications Bachelor's Degree... are directed to appropriate network providers, and obtains prior authorization for in network and out of network services...
evaluating prior authorization requests and conducting concurrent reviews to determine medical necessity for behavioral health... services. Day-to-Day Responsibilities: Process utilization review cases across various levels of care Conduct prior...
. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity criteria... Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State...
. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity criteria... Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State...
Management, or a related field. Clinical credentials such as Registered Nurse (RN) or Licensed Practical Nurse (LPN). Experience...), NCQA and/or state health departments. Experience with EMR systems and prior authorization platforms. Proficient...