care management, utilization review, home care and/or discharge planning. Preferred Registered Nurse (RN) - State... to disease management, resource utilization, access, discharge planning, quality, service and efficiently across the continuum...
of Outpatient Care, Home Health) Utilization Management Experience (EX. Concurrent Review, Prior Authorization, Medical Audits... who are terminal and nearing end of life Care management services includes: nurse education, care coordination...
's Degree preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training... as a Registered Nurse in the State of California. Additional Information Note: Must have Hospital Case Management or Utilization...
Weekly Hours: 40 Additional Locations: Job Information: This position to support Utilization Review revenue cycle... on a regular basis. Within Utilization Review, provides administrative support to the Medical Director, Utilization Review...
with active and unrestricted license Deep experience with principals of coding audit, utilization review and payment integrity... and review criteria to target key claims for review and recovery. Proven experience in rule and content creation, claims data...
(MRN) to determine appropriateness of admission and the appropriate status. Assures robust utilization review and appeals... status orders in the EMR (i.e., inpatient, outpatient, or observation) Perform concurrent utilization review as assigned...
for all payment integrity and utilization management review types or concept. Delivers live training and education via multiple... review audits, quality audits, or appeals when no active training classes are progress. Extensive experience applying...
to ensure delivery of the vision, strategies, and roadmap including utilization outcomes, process metrics, and financial... and initiatives for Integrated Care Management for AAH. Utilization Management - Site oversight for the utilization management...
with active and unrestricted license Deep experience with principals of coding audit, utilization review and payment integrity... and review criteria to target key claims for review and recovery. Proven experience in rule and content creation, claims data...
for all payment integrity and utilization management review types or concept. Delivers live training and education via multiple... review audits, quality audits, or appeals when no active training classes are progress. Extensive experience applying...
the necessity of case management and utilization review for any patient at AZSH. Provides requested documentation... Required Experience Current unencumbered RN license Recent Case Management experience in a hospital setting Utilization review...
AAH site CM leaders to ensure delivery of the vision, strategies, and roadmap including utilization outcomes, process... the needs of the strategic plan and initiatives for Integrated Care Management for AH. Utilization Management - Site...
utilization outcomes, process metrics, and financial performance of all value based contracts (significant impact on the AAH... the needs of the strategic plan and initiatives for Integrated Care Management for AAH. Utilization Management - Site...
including utilization outcomes, process metrics, and financial performance of all value based contracts (significant impact... the needs of the strategic plan and initiatives for Integrated Care Management for AH. Utilization Management - Site...
the necessity of case management and utilization review for any patient at AZSH. Provides requested documentation... Required Experience: Current unencumbered RN license Recent Case Management experience in a hospital setting Utilization review...
of denials, utilization review, or case management experience strongly preferred Other Knowledge, Skills and Abilities... between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner...
, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals. Collects, analyzes and addresses... and interdisciplinary healthcare members. Uses utilization management techniques to determine the medical necessity, appropriateness...
. Assists with concurrent and retrospective utilization review activities including denials and appeals. Works with physicians... with nursing, therapy and other ancillary departments to ensure proper utilization. If no Lead Case Manager, the CM...
field. Master's Degree preferred. Minimum Experience: One year related in acute care facility and/or utilization review... and appropriateness of care; resource Management issues; other issues including concerns involving under/over utilization, avoidable days...
. Provides oversight and monitoring of the medical claims review, appeals, and grievances within CC to ensure timely accurate... are updated at least annually or as needed and presented to appropriate committees for review. Works with all other departments to resolve claims...