compensation discussions begin during the hiring process and may occur during job review and promotional opportunities. Salaries... physicians, nurse practitioners and fellows and serves as care coordinator for the divisional team. The Administrative Medical...
Management Experience (EX. Concurrent Review, Prior Authorization, Medical Audits, Appeals or Delegation) Experience working in... and referral, transition of care planning, acute and catastrophic case management Care management services include: nurse...
utilization review using nationally recognized medical necessity criteria and documents the review. Refers cases for second level... to the infection control nurse. Performs utilization management functions as required by payer source. Complies with the...
as a Utilization Review resource during the global period, acting as a valuable asset for patients by addressing insurance inquiries..., and/or REGISTRATION: Current license as a Registered Nurse (RN) in the State of North Carolina Basic Life Support (BLS...
, coordination of care across the continuum, and utilization review and management. The Manager is responsible for carrying out... of all aspects of the Utilization Management (UM) operations and staff to ensure service levels, business functions and goals...
, coordination of care across the continuum, and utilization review and management. The Manager is responsible for carrying out... of all aspects of the Utilization Management (UM) operations and staff to ensure service levels, business functions and goals...
in care management, utilization review, home care and/or discharge planning. Preferred Registered Nurse (RN) - State... planning of all hospitalized patients. 1. Identifies patients that need care management services (i.e. utilization review...
with contractual agreements. With input from care coordinators manages the timeliness and accuracy of reviews and appeals for denied... with standards, and reflect patient/family/significant other input and choice. 17 Manages the peer review activities of the care...
), and weekend rotation Responsibilities: Essential Functions: Utilization Management- Utilization Review and Care Transitions... utilization reviews daily and/or as required by insurer, (concurrent and retro) for medical and/or psychiatric appropriateness...
when requested. Performs utilization review activities, including preadmission screening, insurance verification... and utilization coordination of the patient's hospital experience. Proactively consults with the interdisciplinary team which includes...
utilization review using nationally recognized medical necessity criteria and documents the review. Refers cases for second level... to the infection control nurse. Performs utilization management functions as required by payer source. Complies with the...
, 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...
of Kansas or obtain within 6 month of hire. Previous experience as a case manager or utilization review nurse.... are determined and files appeals when denials are received. Partners with physician related to resource utilization including...
and procedures for: admission to the infirmary, transfer to emergency room, and utilization review process for specialty consultant... recognized holidays. You can choose to work either 4–10-hour days or 5–8-hour days. You will have your dedicated nurse when...
utilization review, discharge planning, and case management. Experience with Interqual, MCG, CMS LCD, and NCD's Your Name... reviews of medical necessity appeals completed based on Organization payer and adverse determinations documents as to assure...
in care management, utilization review, home care and/or discharge planning. Preferred Registered Nurse (RN) - State... planning of all hospitalized patients. 1. Identifies patients that need care management services (i.e. utilization review...
. How you will make an impact: Perform physician-level case review, following initial nurse review, of high-tech diagnostic imaging... and maintain knowledge of relevant policies and regulations pertaining to utilization review of diagnostic imaging procedures...
Team Meetings and will serve as the Utilization Management psychiatrist for the Center and will develop, review... for confidentiality and compliance. All staff Psychiatrists and Psychiatric Nurse Practitioners will report to the Medical Director...
review of HCS system for accurate data entry; assist/support with training of new staff. Rotating on call schedule with the... Nursing from an accredited school in nursing is preferred. With experience as an infection control nurse in a psychiatric...
patient appeals. Prepare case presentations, as directed, for Medical Grievance Review Claims and Utilization Review Committee.../but not limited to; pre, post, and focused audits, clinical component of appeals, policy preparation and review, creation of Desk Top...