offer. Responsibilities Manage effective utilization review processes, including management of patient statusing processes and monitoring... programs and key performance indicators for all utilization review activities. Interact with medical, nursing, and executive...
, qualifications and comparison with associates in similar roles 2 years Utilization Review experience preferred. Effective... communication with healthcare providers, patients, and insurance companies to explain utilization review decisions. Familiarity...
Authorization and pre-certification, utilization review and denial management, Care Coordination, Collaborative treatment... assigned Registered Nurse (RN) case managers, related activities and workflow to ensure effective and efficient patient care...
must have Utilization Review and Discharge Planning experience. Additional Information As one of the largest health care providers... ability to commute to Grace Medical Center for scheduled shifts.** Position Summary: Conducts concurrent and retrospective chart review...
, qualifications and comparison with associates in similar roles 2 years Utilization Review experience preferred. Effective... communication with healthcare providers, patients, and insurance companies to explain utilization review decisions. Familiarity...
for additional specifics. Responsibilities Manage effective utilization review processes, including management of patient... to develop and implement quality review programs and key performance indicators for all utilization review activities. Interact...
Job Description Utilizing key principles of utilization management, the Utilization Review Specialist will perform.... Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information...
! Job Description Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent... and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, mandates, medical...
required Preferred experience in case management, discharge planning or utilization review Valid Maryland Nursing License... of all assigned patients to identify readmission risks, patient strengths and needs related to clinical resource utilization...
experience required Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid... RN license in the District of Columbia and/or the State of Maryland based on work location(s) Upon Hire required and CCM...
, or utilization issues to appropriate MedStar personnel. Identifies inpatients requiring additional services and initiates care...'s policy. Monitors utilization of all services for fraud, waste and abuse. Performs telephonic ACD line coverage for Clinical...
with all data collections and auditing activities. Accountable for completion of the Annual Standing Order Review and Internal... Classification of Disease (ICD) coding. Manages clinic financials including efficient utilization of supplies or equipment...
with all data collections and auditing activities. Accountable for completion of the Annual Standing Order Review and Internal... Classification of Disease (ICD) coding. Manages clinic financials including efficient utilization of supplies or equipment...
exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities... of care Confers with Medical Director or other leadership as appropriate for review of complex case situations Working...
Authorization and pre-certification, utilization review and denial management, Care Coordination, Collaborative treatment... assigned Registered Nurse (RN) case managers, related activities and workflow to ensure effective and efficient patient care...
, discharge planning, and payer concerns such as LOS. Collaborates with utilization review team members on medical necessity... and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the State of Maryland...
record/EMR. as verified by chart review. Completes required training on electronic documentation. Wound Care- Guides staff... and evaluate wound care products for hospital trial and utilization. Participates in the testing and selection of wound-related...
to plan of care, identification of problems, discharge planning, and payer concerns such as LOS. Collaborates with utilization... review team members on medical necessity determinations. Refers cases that need intervention. Communicates with patient...
regulations and mandates. 35% Organizes the appeal case for physician review by compiling clinical, contractual, medical policy... the written case for review and, following the physician review, communicates the final decision to the member...
experience in Medical Review, Utilization Management or Case Management at Client , or similar Managed Care organization... and Federal regulations and mandates. 35% Organizes the appeal case for physician review by compiling clinical, contractual...