Nurse (RN). One year of Case Management and/or Clinical Care experience. Case Management experience highly preferred..., resource utilization, readmission rates, denials and appeals. Collects, analyzes and addresses variances from plans of care...
discussions related to clinical topics and policy impact Serve as a key clinical resource for health plan or regulatory concerns... in large group settings Perform clinical research as requested through a health technology support line Community and State...
cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and appropriate reimbursement... Will consider non-BSN RN if actively pursuing a bachelor’s degree in nursing with completion within 2 years of hire. 2 years...
clinical, financial and resource outcomes. Essential Duties and Responsibilities Promotes effective utilization... Multidisciplinary Care Team (MDC) and collaborates with other healthcare team members to achieve optimal clinical, financial...
and treatment criteria for patients in a specific department. The Case Manager of Clinical Services specializes in the review.... Understands methods for assessing an individual's level of physical/mental impairment. Assesses patient clinical information...
clinical skills to review and monitor members’ utilization of health care services with the goal of maintaining high quality... necessary to assess a member's clinical condition, identify ongoing clinical care needs and ensure that members receive services...
of positive attributes including: Current RN license in the United States or U.S. territory. 1+ years of clinical experience... following: Under the supervision of a registered nurse (RN), provide professional assessment and review for the medical...
reimbursement, through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting... clinical experience in a psychiatric or mental health setting. Licensure: RN, LCSW, MFT, or MSW degree. Additional...
reimbursement, through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting... clinical experience in a psychiatric or mental health setting. Licensure: RN, LCSW, MFT, or MSW degree. Additional...
Job Description: Inova Fairfax Medical Campus is looking for dedicated Registered Nurse Case Managers (RN... and appeals. Collects, analyzes and addresses variances from plans of care and care paths with physicians and/or other members...
: Required  Licensure as a Registered Nurse (RN), Massachusetts Three years of recent clinical or utilization management experience...: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission...
to use your skills and expertise. Case Manager RN Pulaski, Tennessee Req ID 7415-3210 Post Date Dec. 10, 2024 CategoryRegistered... required documentation to support the appropriate level of care for each patient, including participation in the Clinical Documentation...
: Required  Licensure as a Registered Nurse (RN), Massachusetts Three years of recent clinical or utilization management experience...: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission...
Job Description Job Summary: The Professional Nursing Network RN works with the Nursing Network Team to manage... or standard operation procedures approved by the Clinical and Professional Services Team including scripting, assessments...
Job Summary: The SLH Case Manager RN is responsible for providing comprehensive case management services to clients... and other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. 3. Encourages patients...
criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians... II pediatric trauma designations. The advanced capabilities and clinical expertise within this center have earned it...
/resolves and reports clinical denials/appeals and retrospective payer audit denials. Collaboratively formulates plans of action... in a clinical nursing role Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure...
of Clinical Services specializes in the review of information pertaining specifically to the assigned area (i.e.: Case Management...'s Degree Licensure - Current and unrestricted Louisiana State License as RN Apply now! Here, you are more than an employee...
Summary: We have an exciting opportunity to join our team as a Care Manager (RN) - Evenings *Requires Call*. In this role... clinical criteria including but not limited to InterQual Milliman Care Guidelines MCG etc Collaborates with the Attending...
of all acute clinical areas. Responsible for all insurance authorizations, clinical communication, and denial and appeals. Tracking...Job Description: Position Summary The RN Case Manager is responsible for utilization review and discharge planning...