utilization review/case management/clinical/or combination; 2 of 4 years must be clinical. Skills: Working knowledge of word... review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines...
experience in chart analysis and in the utilization review field. Excellent oral and written communication skills required in... and verification of benefits for incoming patients. Coordinates the utilization management functions of a patient caseload through...
of experience in quality or utilization review. Substitutable Education & Experience (Optional): None. Required Certifications.... Its postgraduate medical education programs include family medicine and transitional year. Job Summary The Quality Review...
continuum and lifespan within protocols set forth and approved by both the nurse practitioner and practice physicians... organization recognized by South Carolina as Nurse Practitioner; CPR, BLS. Required Training: None Essential Functions...
as Nurse Practitioner; CPR,BLS. Required Training: None Essential Functions Documents all situations, both internally... and past medical history and review of systems. Performs appropriate physical examination and orders appropriate diagnostic...
continuum and lifespan within protocols set forth and approved by both the nurse practitioner and practice physicians... organization recognized by South Carolina as Nurse Practitioner; CPR, BLS. Required Training: None Essential Functions...
as Nurse Practitioner; CPR,BLS. Required Training: None Essential Functions Documents all situations, both internally... and past medical history and review of systems. Performs appropriate physical examination and orders appropriate diagnostic...
as Nurse Practitioner; CPR,BLS. Required Training: None Essential Functions Documents all situations, both internally... and past medical history and review of systems. Performs appropriate physical examination and orders appropriate diagnostic...
by South Carolina as Nurse Practitioner; CPR,BLS. Essential Functions Documents all situations, both internally... and past medical history and review of systems. Performs appropriate physical examination and orders appropriate diagnostic...
JOB PURPOSE: Senior Nurse Consultant serves as a member of the clinical and region team, to assist centers in... practices for designated centers. The senior nurse consultant provides education, mentoring and validation of required systems...
health-illness continuum and lifespan within protocols set forth and approved by both the nurse practitioner and practice... by appropriate credentialing organization recognized by South Carolina as Nurse Practitioner; CPR, BLS. Required Training: None...
/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. Skills... and increase member program engagement. 20% Performs medical or behavioral review/authorization process. Ensures coverage...
, this position will include knowledge of Utilization Review rules and regulations as they assist physicians and staff in assigning... In-house Psychiatric Nurse Residency Transition-to-Practice Orientation (20 CEUs) Career development opportunities...
, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case.... Equipment will be provided. Registered Nurse with 5 years nursing experience. Background in med/surg, previous case management...
utilization review, discharge planning, and case management. Experience with Interqual, MCG, CMS LCD, and NCD's Your Name... to audit review (or more frequent review as requested) for contracted clients. Interfaces with IT and provides direction...
of medical claims and utilization practices. 80% May provide any of the following in support of medical claims review... and utilization review practices: Performs medical claim reviews and makes a reasonable charge payment determination. Monitors process...
. Minimum Years of Experience: 5 Years of experience as a registered nurse, including at least 2 years of utilization review, quality... on Stroke Team Required Certifications/Licensure: Currently licensed as Registered Nurse by the State Board of Nursing...