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To act as liaison between Case Managers, home Health nurses, Utilization Review, etc. To counsel with patients and family members on treatment and conditions of patients. To assess, develop, implement and evaluate the nursing care and treatment for patients in an assigned clinical area.
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This role involves both individual and family work, case management, utilization review, and discharge planning. Maintain knowledge of clinical information for patient's stay by review of documentation, participate in staffing, attend care conferences and collaborate with other members of the treatment team.
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Prior utilization review experience from a NJ/NY Automobile, Workers Comp, or Managed Care company is a plus. In this vital role the Nurse Case Representative medically manages the treatment of our customers injured in an automobile accident in accordance with state and company guidelines.
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Participate in student clinical clerkships and affiliation programs in agreement with the AOTA's clinical education agreements from schools Attend and/or participate in facility meetings as directed by Center Manager (may include utilization review, infection control, disaster preparedness, etc.
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Conducts concurrent daily chart review, investigating patient history, symptoms, clinical status, and treatment utilizing Interqual ISD criteria as a tool to determine a patient's severity of illness and the intensity of service.
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Assesses need for continued care for patients, applies utilization review concepts according to federal, state, and JCAHO guidelines. Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
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Responsibilities Below is a list of your responsibilities as a Utilization Management Specialist 2 with YesCare : Responsible for the implementation of a comprehensive outpatient/inpatient review process utilizing criteria based review standards and standards of best practice.
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Clinical professional is 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/resource utilization.
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Demonstrates understanding of utilization review process to include treatment criteria and precertification payor to obtain initial authorization of care and document same with pass to the Utilization Management team for concurrent reviews.
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The BH Care Manager I responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review.
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Participates in Southwestern Mental Health Center, Inc. peer review utilization and quality assurance projects and procedures. Provides individual, group, and family psychotherapy or skill building activities (within limits of experience and education background) including assessment, treatment planning, treatment, referral, termination, and emergency/crisis intervention services, as indicated to meet the needs of clients, including addressing failure to appear clients before 3rd consecutive no-show visit.
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Knowledge of acute psychiatric treatment, treatment settings/clinical level of care guidelines, psychiatric diagnoses, behavioral health utilization review and appeals procedures.
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Meet with ABA supervisors bi-weekly to review client progress, data collection, specific curricula/goals, functional behavioral analysis, and utilization of authorized hours. Serve as a leader in one of our Autism Learning Centers on the South Coast, collaborating with senior leaders and a team of internal and external consultants to provide state-of-the-art services to children on the Autism Spectrum, combining Skill-Based Treatment and Pivotal Response Treatment.
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Attend and participate in assigned case conferences, treatment planning meetings and utilization review. Assess and review medication regimen with patient, guardian(s), team members and other care providers/advocates.
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River Oaks Hospital is seeking a dynamic and talented UTILIZATION REVIEW COORDINATOR who Evaluates patient medical records to determine severity of patient's illness and the appropriateness of level of care.
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utilization review treatment jobs
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