Director of Case Management Greater Providence Massachusetts Area The RN Director of Case Management is responsible... for Case Management, Utilization Review, Integrated Clinical Service, Discharge Planning and Care Transitions. The Director...
advocate, and change agent to achieve optimal clinical, financial, and resource outcomes. Qualifications: RN required MSN... for specific patient populations transitioning from inpatient to outpatient care. The RN Director of Case Management oversees daily...
LifeMart Responsibilities: Filing documents as needed. Initial Precertification with payors. Concurrent Clinical review... of protected health information and patient information. Reconsiderations, assists with appeals as needed, arrange peer to peer...
. Retrieve clinical related messages and return calls within 48 hours. Manage and resolve UChart messages. Submit lab order... and procedures. Process appeals and peer to peer reviews. Assess barriers to care and refers to support services. Review outside...
requested by provider/pharmacy Notify provider of appeals/denials Arrange appeals/peer review for providers Patient phone... call Patient evaluation- Nursing (clinical) assessment of symptoms or clinical concern Secure message provider...
and coding content that will drive decision-making and documentation for the Clinical Services, Quality and Appeals teams. SME... development and performance of our clinical and coding products including Itemized Bill Review, DRG Validation, Outpatient...
and coding content that will drive decision-making and documentation for the Clinical Services, Quality and Appeals teams. SME... development and performance of our clinical and coding products including Itemized Bill Review, DRG Validation, Outpatient...
legibly and accurately. Forwards areas requiring clinical information to LPN, RN or Licensed Provider. Secures appropriate... to prescription information to RN/LPN/Provider. Initiates and follows-up on pre-authorizations and appeals and arranges peer-to-peer...
, AFSME, AFL-CIO. Placement within the range is based on years of RN experience. What You Will Do The RN CM I assesses... areas. This position requires the ability to combine clinical/quality considerations with regulatory/financial/utilization...
Responsibilities: Filing documents as needed. Initial Precertification with payors. Concurrent Clinical review with payors... of protected health information and patient information. Reconsiderations, assists with appeals as needed, arrange peer to peer...
in nursing or other clinical field required. Master's Degree in clinical field preferred. (RN and LPN preferred.) Six..., administration, clinical, nursing, business and UR staff about impending review issues. Ensure UR information is updated, correct...
Job Description: Job Description The RN Case Manager 1 provides discharge planning and continuity of care... in clinical performance improvement activities. Job Responsibilities Collects delay and other data for specific performance...
will be given to candidates holding an ADN or diploma degree who are currently enrolled in a BS in nursing or RN-MSN program... and appeals. Leads and directs the daily operations of the Utilization Review Specialists and Adminstrative Assistant staff...
and advocate for a particular level of care based on the presenting clinical information. Coordinate with colleagues and payors.../case managers to obtain pertinent clinical and discharge information. Learn UR Tracking System, Midas; enter daily...
in our positive clinical outcomes, resident and family member testimonials, customer satisfaction ratings, AHCA Quality Awards and the... and completion of clinical assessments, supporting documentation, care planning, and transmitting MDS 3.0, all as required by federal...
and communicates on-going staffing needs. Makes recommendations to the Director of Clinical Services regarding staffing solutions... to meet day center needs in partnership with Day Center Manager. Provides clinical direction or assistance as requested...
, and follow-ups on insurance denials, appeals, and reconsiderations. You will collaborate with clinical staff to ensure optimal... correspondence related to certifications, appeals, and denials is properly documented and stored. Collaborate with clinical...
Required - Certification as CPC, CCS, CHC, RHIA, RHIT, RN, or LPN or other related certification. Knowledge Skills and Abilities (KSAs... judgment on behalf of the company's welfare. Ability to travel across system. Job Duties Independently completes clinical...
, and follow-ups on insurance denials, appeals, and reconsiderations. You will collaborate with clinical staff to ensure optimal... correspondence related to certifications, appeals, and denials is properly documented and stored. Collaborate with clinical...
resources management. Essential Duties: Leadership & Supervision: Manage and mentor a team of RN Utilization Review... provided by personnel. Clinical Review Oversight: Supervise the clinical review process to ensure reviews are conducted...
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