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Insure TMH compliance with federally mandated Utilization Review functions. The most advanced cancer, heart and vascular, orthopedic & surgery programs in the Panhandle. Supervises: RN/Case Management; Social Worker/Case Management; Case Management/Referral Coordinator (JC: 244802, 242002.
Full-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Performs Minimum Data Set (MDS), case management, utilization review, quality assurance (QA), and discharge planning duties. The most advanced cancer, heart and vascular, orthopedic & surgery programs in the PanhandleOur system also includes a psychiatric hospital, multiple specialty care centers, four residency programs and nearly 40 affiliated physician practices.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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JOB SUMMARYThe RN Utilization Review coordinates care for OPIS patients who are high cost, complex, and at risk. NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.
Full-timeExpandUpdated 8 days ago - UpvoteDownvoteShare Job
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Completing HMO referral forms; transmitting information to insurance companies for preadmission screening or utilization review. Assisting doctor in hospital or office-based surgery setting, rounds, procedures, surgery, as mutually agreed upon.
Full-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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2 years of consecutive utilization management, utilization review or case management experience. Decypher is seeking a Registered Nurse Case Manager/CAMO. Analyzes medical referrals/appointments and general hospital procedures and regulations by monitoring specialty care referrals for appropriateness, covered benefits, and authorized surgery/medical procedures, laboratory, radiology and pharmacy.
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Sitting, walking, and/or standing for up to 90% of work time when doing Utilization Review, Preauthorizing Orthopedic and Urology surgeries and Mental Health Assessments, etc. Contacts patients to discuss authorization status and schedules a Pre-Admission visit with the Nurse Educator for all surgery cases.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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The primary duties are as follows: 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, physician’s orders, physician visits, recertifications, etc.
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Knowledge of insurance, utilization review, scheduling requirements and support of front desk responsibilities. California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians; IV Certification (NPTA Sterile Product Certification) - Various-Employee provides certificate; ACLS Certification (Advanced Cardiac Life Support) - American Heart Association; AHA Basic Life Support for Healthcare Professional (AHA BLS Healthcare) - American Heart Association.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Experience in case management field including utilization review, discharge planning, outcomes management, assessment care planning and care coordination, related experience or training preferred.
Full-timeExpandApply NowActive JobUpdated 23 days ago - UpvoteDownvoteShare Job
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Requires PALS (or must obtain within 6 months of hire date) if assigned to: Emergency Rooms, Infant Follow-Up, Surgical Services (only PACU & Same Day Surgery), Pediatrics/Pediatric ED. ENPC accepted in lieu of PALs for Adult Emergency Room.
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Assisting doctor in hospital or nursing home activities, rounds, procedures, surgery, as mutually agreed upon. A current license to practice as a Registered Nurse in Indiana and one year of related nursing experience is required.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Experience specializing in utilization management (levels of care knowledge and demonstrable competence with evidence-based criteria tools), discharge planning to entities throughout a continuum of care, previous care management or third-party insurance review required.
Full-timeExpandUpdated 4 days ago - UpvoteDownvoteShare Job
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Minimum of 3-5 years as a pre-authorization or utilization review nurse in a payer or acute care setting; preferably medical-surgical or critical care/ED. Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) or Certified Case Manager (CCM) preferred.
Full-timeExpandApply NowActive JobUpdated 21 days ago - UpvoteDownvoteShare Job
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Experience as a Registered Nurse/LPN in the field of mental health/retardation or Drug Treatment Experience in utilization review and/or quality assurance in a healthcare setting. Develops, implements and evaluates the surveillance of utilization review process to ensure quality services.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Triage accounts to identify complex clinical requirement cases and/or escalate any issues to clinician for Peer to peer and/or denials Complex cases needing authorization i.e. surgery/wound care/chemo/complex RAD for medical necessity clinical pre-authorization.
Full-timeExpandApply NowActive JobUpdated 8 days ago
utilization review nurse surgery jobs
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