, 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...
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...
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...
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...
-effective utilization of available resources (human, material and financial) and ensures a high level of quality of care... actions. Maintains ongoing communication with associates to review programs, provide feedback, discuss new developments...
-effective utilization of available resources (human, material and financial) and ensures a high level of quality of care... actions. Maintains ongoing communication with associates to review programs, provide feedback, discuss new developments...