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Follows all cases throughout the duration of the admission, working with Utilization Review (UR) Department every few days in Ontrac to send concurrent review clinicals. Determines eligibility for admission/treatment in compliance with hospital policy, utilization review criteria, and State and Federal regulations and/or guidelines.
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The Utilization Review LVN nurse will perform documentation review for medical necessity and benefit correlation of requested medical and surgical procedures, services and admissions for HMO, PPO and POS products.
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The review of care is region specific and consists of outpatient healthcare services on pre-certification requests, outpatient procedures, outpatient services, elective inpatient admissions, home health services, genetic testing, orthotics, prosthetics and complex durable medical equipment.
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Currently has or is able to achieve and maintain certification as a Certified Professional in Healthcare Management, a Case Manager, or Utilization Review/Utilization Management Professional as directed by IHSC through formal training and other means.
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To act as liaison between case managers, home health nurses, utilization review, etc. To coordinate the operations of a clinical area including patient scheduling, maintaining patient records and managing the patient admissions process.
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Wellness Resource Center is looking to hire a Full Time Utilization Review Specialist. Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department :High school diploma or equivalent required.
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Collaborates with the Utilization Review Specialist RN regarding medical necessity of inpatient admission, appropriate patient class and duration of hospitalization. The Care Coordination Nurse is responsible for ensuring the provision of quality patient care in the appropriate setting through care coordination, case management, utilization management of inpatient admissions, and transitions of care to different levels of care.
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Conduct intake assessments to collect medical, social, emotional, and demographic data to assess for appropriate admissions into Withdrawal Management based on written policies and the Utilization Review manual.
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The Prior Authorization Specialist (PAS) is an essential role responsible for facilitating exceptional patient experience, by securing authorizations for all scheduled services related to medical and surgical admissions across entities, including BWH OR procedures, BWFH OR procedures, FXB OR procedures and BWH/BWFH Endoscopy Suite procedures in accordance with standards established by the Department, Hospital, Medical Staff, and outside regulatory and accreditation agencies.
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Provide timely responses and detailed clarification for all utilization review specialist requests. Engage clinical team, administrative staff, and the utilization review department upon admission and for duration of treatment to provide detailed medical necessity criteria to drive authorization and retention through individualized care.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Working knowledge of admissions and intake, Utilization Review, and 3rd party or insurance payers. Licensed in a clinical counseling field (e.g. LPC, LMFT, LMSW, LCSW) Monte Nido Portland, located in West Linn, OR is a residential treatment program exclusively for adults seeking treatment for Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, or Exercise Addiction.
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Clinical professional responsible for facilitating admissions, clinical intake assessments and utilization review processes to assure continuity for the most appropriate level of care for patients and their benefit/resources utilization.
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As the House Supervisor, will be responsible for collecting and analyzing data on patient admissions, transfers, and bed availability in specified clinical areas to improve patient care and maximize bed utilization.
$36.5 - $68ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Minimum one year of psychiatric, utilization review or quality assurance experience preferred. Serves as a resource for staff in the area of Joint C ommission standards and those of private utilization review agencies.
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ABQAURP (American Board of Quality Assurance and Utilization Review Physicians), with a physician advisor sub-specialty. This position will be an active member of the Utilization Review Committee.
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