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The activities will include daily review of hospital care by chart review and discussion with attending physician, admission and concurrent review for inpatient admissions, meetings with patient and families to develop discharge planning, identification of patients for ambulatory case management, communication with case managers, home care reviewers, social workers, members and providers, quality improvement reviews, and education of the member/family, provider and hospital staff.
$78,300 an hourExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Follows general technical direction from nurse manager, senior medical and disability case manager and/or CCMU staff to resolve highly complex medical and/or RTW issues and/or successfully manage catastrophic injuries.
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Proactively conduct concurrent review of inpatient utilization according to identified criteria, and properly documenting decision including all appropriate legal and regulatory requirements.
$82,800 - $115,100 a yearExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Participates in Departmental Quality Assurance activities and Utilization Review activities as requested. Notifies the patient’s attending MD, Podiatrist and other professional persons and responsible staff of significant changes in the patient’s condition in a timely manner.
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INTERVENTIONS - Monitor and evaluate short-term and long-term patient responses to interventions in collaboration with quality assurance and utilization review, maintaining interdependent follow-up as necessary.
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Psychiatric Nurse practitioners may participate in utilization review activities as needed to ensure patients are able to access necessary careThe Psychiatric Nurse Practitioner will fulfill all duties in compliance with Pioneer Rural Health procedures including 42 CFR, Part 2 (privacy regulations.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Knowledge of insurance, utilization review, scheduling requirements and support of front desk responsibilities. California Registered Nurse (RN) - CA Board of Registered Nursing; AHA Basic Life Support for Healthcare Professional (AHA BLS Healthcare) - American Heart Association.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Appropriately utilizes internal and external resources and referrals i.e., Utilization Review, Peer Review, Field Claims Specialists, Regional Medical Director Consults, and Vocational Rehabilitation to achieve best possible case outcome.
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Participates in leadership team by actively contributing in decision making, grievance follow up, building and company-wide initiatives and attending leadership team meetings such as daily stand up, Managing Acute Care Conditions (MACC), Nutrition at Risk (NAR), Utilization Review (UR), Quality Assurance Performance Improvement (QAPI) and other meetings as required.
Full-timeExpandApply NowActive JobUpdated 23 days ago - UpvoteDownvoteShare Job
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Responsible for daily completion of the following tasks: daily management of KPIs, field staff support, order approval, follow-up on pending admissions, prep/perform utilization management review, workflow, edit/lock TIF/Discharge OASIS, escalation/complaint calls, supervision to ensure implementation of agency policies & procedures, and field visits as required.
$80,000 - $90,000 a yearExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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The Evening shift Supervisor must be a Registered Nurse currently licensed with the State of Ohio. This position reports directly to the DON, holding a position of management and consultation with Administrative and Medical Staff.
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Maintains ongoing communication with the patient, family/significant other, physician, nursing staff, discharge planning nurse, utilization review nurse, and/or other members of the healthcare team concerning the status of the discharge plan and documents such in the medical record.
Part-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Coordinate and communicate with Utilization Review Nurse on a daily, consistent basis to ensure patients are in the right status and level of care. Job Summary Responsible for providing comprehensive assessment, planning, implementation and overall evaluation of individual patient needs; Works collaborate with the Physicians, patient/family, nursing, utilization review and other members of the healthcare team to assure patient management that efficiently and effectively aligns with patient needs using resources to meet quality, clinical and cost effective outcomes.
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Act as a resource for hospitalists, SNFs, outpatient utilization management staff, home health care agencies, Employer home-visit physicians and nurse practitioners. Will support the Clinical Manager of the daily operations of the Program and Department and for operational partnership with concurrent review team managing inpatient and SNF admissions, home health care services, home visit program staff, hospice agencies, and preauthorization department.
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Nurse practitioners may participate in utilization review activities as needed to ensure patients are able to access necessary careThe Nurse Practitioner will fulfill all duties in compliance with Pioneer Rural Health procedures including 42 CFR, Part 2 (privacy regulations.
Full-timeExpandApply NowActive JobUpdated 4 days ago
utilization review nurse staff jobs
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