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Performs the appropriate utilization review functions utilizing medical staff-approved decision support criteria (InterQual Intensity of Service, Severity of Illness criteria). Utilization Management Mgr 1.
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This is a hospitalist position and will include L&D patient management, ED and IP consults and treatment as needed, after hours call coverage for office patients after nurse triage. Obtain health history and perform examinations Diagnose and direct counseling for each patient on a plan for treatment Prescribe medication in accordance with Indiana statute and professional guidelines Perform procedures in accordance with professional credentialing Arrange referral for patients requiring services outside of the scope of specialty area, including transfer to inpatient care Review In-Basket each work day and addresses time sensitive patient information with appropriate urgency.
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Participates in Performance Improvement, Utilization Review, Fire & Disaster Committees, and others as requested. The Psychiatric Nurse Practitioner is responsible for proving psychiatric assessments and ongoing treatment to all clients.
$75 - $85 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The PCS Case Manager/Utilization Review Nurse acts as a liaison and facilitator for the patient, his/her family, physicians, hospital administration, and staff personnel regarding problem-solving in discharge planning and management of complex medical and psychosocial issues.
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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; ACLS Certification (Advanced Cardiac Life Support) - American Heart Association.
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Develops and implements case management programs, including utilization review, intake or discharge planning, and managed care contracting or negotiation. Oversees a staff of case managers responsible for patient care coordination.
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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.
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During this individual supervision a chart review should be completed using the updated Utilization Review sheet with particular attention paid to whether or not a PGP exists to cover the time period since the last CBH review.
$57,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Provide direct supervision to nursing staff throughout the shift in conjunction with the Nurse Manager, House Charge or CNO as appropriate. Distributes documentation of admissions to the Business Office, Admitting Unit and the Utilization Review Department.
$123,968 - $142,480 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Participates in infection control, utilization review, case management, and quality assessment activities and analysis. Demonstrates appropriate delegation of tasks and duties in the direction and coordination of health care team members, patient care, and department activities in accordance with Kansas State Nurse Practice Act. Selects, schedules, assigns and evaluates staff, adjusting hours and shifts as necessary.
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Preferred Education BSN: Bachelor of Science Nursing Required License and Certs FL RN: FL Registered Nurse License- Require one (1) year of case management or utilization review experience in a hospital setting; utilization experience preferred or qualified graduate of the SMHCS internal ICM Residency program.
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Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.
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We are in search of a qualified RN Unit Manager to be a leader in our facility - Unit Managers are primarily responsible for overseeing day to day patient care, supervising, directing and developing nurse staff, and reporting to the Director of Nursing to ensure quality patient care within a long-term care center, skilled nursing facility or assisted living community.
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Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred. Responsible for working collaboratively with physician partners to optimize quality and efficiency of care for hospitalized members by carrying out daily utilization and quality review, monitoring for inefficiencies and opportunities to improve care, developing a safe discharge plan to include recommending alternative levels and sites of care when appropriate.
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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.
$115,000 - $140,000 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago
utilization review nurse staff jobs
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