appeals to third party payers Recordkeeping: Maintains appropriate records of the Utilization Review Department Training...
: Prepare and submit appeals to third party payers Recordkeeping: Maintains appropriate records of the Utilization Review...
in a utilization management review or a case management setting within the preceding five (5) years. Notwithstanding the aforementioned... of an accredited Certified Professional Utilization Review (CPUR) program Certified Case Manager (CCM) issued by the Commission...
in a utilization management review or a case management setting within the preceding five (5) years. Notwithstanding the aforementioned... of an accredited Certified Professional Utilization Review (CPUR) program Certified Case Manager (CCM) issued by the Commission...
Responsibilities Participate in Utilization Management/Case Management meetings to review and identify opportunities to improve... and implementation of the Case Management Program (CMP). Develop local strategies that use the strength and disciplines of both nursing...
as analyzing, interpreting and presenting clinical quality-related data Previous case review experience Preferred... case review process, including performing case reviews and directing the assignment and completion of high quality reviews...
targeted interventions, disease management, case management or complex case management services to help mitigate risk..., and other regulatory bodies related to PHM, CCM and DM. Required Qualifications Master's Degree in Nursing 3 Years Case management...
in a managed care health plan or, 2 years of experience in utilization review, case management, and/or discharge planning or, 2... review, case management, and/or discharge planning OR 2 years of experience in transitional care and acute care settings...
youth overcome trauma and challenges that put them at risk, including case management, counseling, mental health treatment... offers a comprehensive benefits package to full time employees that includes generous PTO, personal holidays, health, vision, dental, life...
specifics and support questions associated with payer policies (e.g., utilization management, denial, and appeals), drug... (as needed). Interface with Patient Support Center (hub) on important matters related to patient case management, including tracking cases...
-Exempt, Full Time Salary: $28.50-$31.00, per hour; Commensurate with experience Summary: Be a part of a multi... follow-up Provide triage and assessment of walk-In clients, if needed May provide case management, including...
with American Association of Suicidology (AAS) for both telephonic and chat services. Utilization Management Afterhours – Review..., case consultation with multidisciplinary team; case management; develop treatment plans with short/long-term goals...
and review to identify areas requiring intensive management. Refers to case management officials if needed. Receives and makes... and beneficiaries. This Licensed Practical Nurse will provide utilization management activities in the Referral Management Center...
: Job type: Regular Full Time Competitive Salary with Excellent Benefits Retirement Plan with Employer Match Paid Time Off, Extended... scope of practice; provides medical nutritional therapy. Ensures maximum utilization of schedules by proactively managing...