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Our beautiful, recently updated building overlooking the majestic Columbia River offers care team members a unique opportunity to work a mix of short- and long-term skilled nursing and rehabilitative care.
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Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
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In collaboration with the Utilization Management RN, coordinates participant admissions/discharges to/from short term rehab or long-term care including making referrals to LTC facility, arranging transportation, and providing any necessary paperwork.
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Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers’ compensation claims.
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Job Summary:Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care. As necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization of covered treatments and genetic testing.
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Document the pre-certification review in a complete, concise, and accurate manner in the pre-certification computer application. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology.
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About Enterprise Solutions Inc ESI presents healthcare professionals across all 50 states with a range of options including short and long-term contracts, permanent placements, and travel opportunities.
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Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services.
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Genesis HealthCare is one of the nation's leading providers of healthcare services from short-term to long-term care and a wide variety of living options and professional clinical services.
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Conduct peer-to-peer discussions with ordering physicians, physician assistants, and nurse practitioners to provide education regarding established guidelines and accepted standards of oncology care.
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Unless expressly allowed by state or federal law or regulation a must be located in a state or territory of the United States when conducting a utilization review or an appeals consideration and cannot be located on a US military base, vessel, or any embassy located in or outside of the US.Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
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Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues. Relying on clinical background, reviews health claims providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with Concentra Physician Review policies, procedures, and performance standards and URAAC guidelines and state regulations.
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INTERVENTIONS - Monitor and evaluate short-term and long-term patient responses to interventions in collaboration with quality assurance and utilization review, maintaining interdependent follow-up as necessary.
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Conduct initial and ongoing assessments, initiate disease management protocols, determine and manage outcomes, ensure continuity of care through discharge planning, utilization of resources and analysis of variances.
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DATA - Perform assessment, data collection, obtain, review, and analyze information in collaboration with the patient, family, significant others, health care team members, employers, and others as appropriate.
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long term care short utilization review jobs
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