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Work with Primary Care Coordinators (PCC's) to provide monthly Chronic Care Management (CCM) visits and care; review and sign off on CCM documentation by PCC's. Additionally, we provide rapid access to medical care by offering same-day or next-day appointments for urgent issues, helping reduce the need for unnecessary emergency room visits and hospital admissions.
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As a Utilization Review Specialist, you will accurately and timely complete utilization review activities. WestPark Springs is a 72 bed behavioral hospital located in Richmond, Tx. The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their families.
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Maintains an active role in assuring the continuity of care for all inpatients through early discharge planning and working with hospital Social Worker discharge planning staff. Minimum 3 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in managed care utilization review, quality assurance, discharge planning.
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Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll, and physician billing.
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LifeBridge Health includes Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital and Grace Medical Center, as well as our Community Physician Enterprise, Center for Hope, Practice Dynamics, and business partners: LifeBridge Health & Fitness, ExpressCare and HomeCare of Maryland.
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The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services.
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Reports directly to the JHH VP of Care Coordination/Utilization Management and indirectly to the JHBMC Senior Director of Care Management and is responsible for the coordination, management and success of The Johns Hopkins Hospital and The Johns Hopkins Bayview Medical Center Utilization Management programs.
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The Medical Director, working together with a coder (DRG Integrity Specialist), will review inpatient charts to ensure the acuity and complexity of the patient's hospital stay is appropriately captured in the clinical documentation and translated into coding.
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Work with their manager to review tower analytics, identifying trends and actionable steps to improve opportunity capture rate and drive results for clients. The Medical Director works with the DRG Integrity Specialist to confirm the principal diagnosis and the appropriate Diagnosis Related Group (DRG) of every case in compliance with coding guidelines.
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Maintain a functional and collaborative relationship with the DRG Integrity Specialist to achieve shared company goals. This process also involves the Medical Director confirming procedures, dates, and complication or comorbidity (CC) or major complication or comorbidity (MCC) when used as a secondary diagnosis.
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Established in 1986, our high-tech and high-touch offerings include innovative medical management systems, face to face community care coordination services, utilization review, clinical data integration and business intelligence analytical reporting – all focusing on increased quality outcomes and optimization of provider and payer networks.
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Fairview Park is the largest hospital in Middle Georgia between Macon and Savannah. Participation in scholarly activities, which may include peer reviewed funding, publication of original research or review articles in peer-reviewed journals, chapters in textbooks, publication or presentation of case reports or clinical series at scientific society meetings, or participation in national committees or educations organizations.
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You will review and make recommendations to the Hospital Administrator for any changes or additions necessary to ensure the highest quality of patient care. As a Medical Director, you will be responsible for providing supervision and clinical leadership for psychiatric care and practices, including attending multidisciplinary teams and court proceedings, and leading peer review for best practice projects.
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Ochsner was also recognized by Becker’s Hospital Review as one of the “150 Great Places to Work in Healthcare. Ochsner is the only hospital in Louisiana recognized by U.S. News & World Report as a “Best Hospital” in three specialty categories and as well as receiving five star ratings for six conditions and/or procedures.
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A background including a federal judicial clerkship and/or membership in law review is preferred. An incredible opportunity to join a prestigious acute-care teaching hospital in Maryland as the Vice President Nursing Operations.
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