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Manages a radiation dosimetry program serving in campus and partner institutions that includes assignment and delivery of dosimeters, maintenance of the dosimetry database, ALARA investigations, dosimetry vendor liaison including contract and invoicing review, dose reconstructions, and medical x-ray procedure and time analysis.
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As a RN Clinical Reviewer, you will play a pivotal role in managing daily operations, ensuring adherence to regulatory standards such as NCQA, URAC, and other relevant industry benchmarks. Minimum of 1 year of experience in Utilization Review (UR), Prior Authorization, or a related field is required.
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Performs inpatient chart review to determine appropriate DRG assignment and assures appropriate documentation in the chart to support clinical care provided, including severity of illness and risk of mortality which impacts Case Mix Index and mortality ratings.
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Ensures daily chart review, utilization reviews, coordination of discharge planning activities and comprehensive clinical documentation in the electronic medical record. Performs variance tracking, outcome analysis and identifies problems to assess the effectiveness of the clinical pathways.
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REQUIRED:Candidates are required to either have an MD, PhD, or DO. Experienced in interpreting primary data; chart reviews and clinical trials, survey data such as NHANES, NHIS, and administrative datasets such as VHA, CMS, NIS, NSQIP.PREFERRED:MD, Phd in Epidemiology preferred.
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Licensed in a clinical counseling field (e.g. LPC, LMFT, LMSW, LCSW) Working knowledge of admissions and intake, Utilization Review, and 3rd party or insurance payers. The Mental Health Clinical Director is responsible for the overall clinical quality of our treatment program.
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Build profitable business and script growth through recommended clinical programs including appropriate immunization and when available MTM (Medication Therapy Management), DCS (Diabetes Care Specialist), and all ongoing other programs as identified.
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The CDI RN Specialist will ensure overall quality and completeness of clinical documentation for specified populations. Educate members of the patient care team regarding specific documentation needs; education team members about reporting and reimbursement issues identified through concurrent/ retrospective documents review and aggregate data analysis.
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Explore the career pathways in Behavioral Health, Substance Use and Recovery, Community Based Clinical services, Adolescent and Family services, Adult Residential, Maintenance and Administration.
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Through the use of clinical tools and information/data review, conducts an evaluation of members needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
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The clinical liaison will review and evaluate prospective resident referrals by the approved clinical capabilities, bed availability, integrated eligibility, and sex offender status to provide an immediate response to the referral partner, and effectively communicate the determination with the community.
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Required experience: minimum of two years recent management experience; three years of hospital clinical nursing experience and one year experience in case management, utilization review or hospital quality assurance.
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Werfen, founded in 1966, is a worldwide developer, manufacturer and distributor of specialized diagnostic instruments, related reagents, automation workcells, and data management solutions for use primarily in hospitals and independent clinical laboratories.
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Review pre-bill cases simultaneously with a physician during each work shift excluding breaks and meetings to analyze and validate diagnosis and procedure codes for inpatient services via coding compliance and clinical knowledge to support accurate DRG assignment.
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Advise, support, and consult with technologists, radiologists, and Radiation Safety Officer (RSO) regarding clinical protocol management, dose assessment, and review of Radiation Protection Program Elements.
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