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Come to sunny Florida and join Palm Beach Health Network as a dedicated Utilization Review Physician Advisor serving two of our premier Florida facilities. Come to sunny Florida and join Palm Beach Health Network as a dedicated Utilization Review Physician Advisor serving two of our premier Florida facilities.
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Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Chattanooga, Tennessee. Posted job title: Case Management (Utilization Review)About Medical Solutions.
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Previous experience in a leadership position in managed care is preferred, with knowledge and understanding of utilization review and quality management procedures. Reporting to the Chief Medical Officer, this position provides clinical leadership and oversight of the population health management program including utilization management, case management, preventive health/disease management, and quality management while supporting the multidisciplinary member-centric approach to care management.
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Our focus is Utilization Review with care coordination of our patients and some discharge planning. Our purpose is to provide high quality care through appropriate resource allocation, to assure effective and efficient utilization of hospital facilities and services and help facilitate improving maximum financial strength for the hospital system.
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Credentialing in health information/coding or auditing (e.g. RHIA, RHIT, CCS, CCS-P, CPC, or CFE), experience with utilization review, coding, or retrospective medical claim auditing strongly preferred.
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Other non-qualifying experience including, but is no limited to, experience in experimental psychology, research psychology, industrial psychology, organizational psychology, utilization review, guidance counseling, etc.
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In collaboration with physicians, population health staff, employers, community organizations, hospital-based case managers/utilization review staff, clinic-based care coordinators/preauthorization staff, and Insurance Division staff, the RN Case Manager encourages the best possible outcome in the most cost effective manner in accordance with standards set forth by National Committee for Quality Assurance (NCQA.
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Plan, develop, organize, implement, evaluate and direct the Nursing Services Department, as well as related programs and activities including, but not limited to - Infection Control practices, Utilization review and Triple check, Upkeep of all QA logs, PAE and PASSR log, physicians orders, physician visits, recertifications, etc.
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3 years of hospital-based Case Management experience including Utilization Review and Discharge Planning experience. Coordinates and participates in hospital utilization review process.
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To act as liaison on between case managers, home health nurses, utilization review, etc. After you apply, we will review your qualifications and contact you if your application is among the most highly qualified.
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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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May collaborate as assigned with utilization review specialist to obtain necessary insurance authorizations and concurrent reviews as necessary. The crisis clinician is responsible for gathering a psychosocial evaluation through interviews and record review and completing a written assessment with case formulation and treatment plan, including risk assessment and level of care recommendation.
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Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.
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Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Port Charlotte, Florida. Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Port Charlotte, Florida.
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Monogram's innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum.
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review utilization jobs
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