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Our focus is Utilization Review with care coordination of our patients and some discharge planning. Our purpose is to provide high quality care through appropriate resource allocation, to assure effective and efficient utilization of hospital facilities and services and help facilitate improving maximum financial strength for the hospital system.
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Job DescriptionFacilitates quality and efficient patient intake process through pre-registration, registration, insurance, precertification verification, document completion, POS collections, and work output review.
$15.75 - $21.26 an hourPart-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Preferred Qualifications: Bachelor's degree Nursing 1 year Case management or utilization review experience within the last three years preferred. The RN case manager role integrates the functions of utilization management, quality management, discharge planning assessment, and coordination of post-hospital care services, including transfers to an alternative level of care.
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Review historical production rates, material pricing, and equipment utilization. Ability to understand and use multiple platforms (internally and externally) to manage projects (HCSS, Bluebeam, etc.
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Support an ongoing review process for the standard operating procedures and guidelines for equipment reliability and breakdown management, which will support APMT in sustaining safe operation of all terminal equipmentExercise management authority to promote total-terminal success in accordance with the leadership’s strategic vision, including optimization of work processes and efficient manpower utilization.
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Troubleshoot utilization review and medical necessity related issues utilizing AMM or other UR vendor's website information, and route claims for review accordingly. The Medical Claims Adjuster is responsible for the review, investigation, decision making, and processing of production claim types, and all related claim functions and activities.
RemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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ESSENTIAL DUTIESThe primary responsibility of the Utilization Review Specialist is to review medical records and prepare clinical appeals (when appropriate) on medical necessity, level of care, length of stay, authorizations and denials for patients.
$56,305 - $69,201 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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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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Prepare pre-certification/authorization information to insurance utilization review team and subsequent concurrent review (continued stay) clinical reports per medical necessity criteria.
$68,000 - $90,000 a yearFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Facilitates the utilization of resources to meet patient outcomes and contribute to Facility (AMC), New York State and National Quality data metrics. Performs review and triage of incoming test results, patient requests and pharmacy renewals; facilitates call-backs to patients as necessary.
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Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. As necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization of covered treatments and genetic testing.
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Communicates with patients, Utilization Review, Financial Counselors, etc. Insurance Verification Specialist Requirements: 2 Years experience in any of the following departments: Medical Insurance Verification, Pre-Certification, Patient Registration, Hospital Admissions or Patient Access Information ~Flu Shot REQUIRED.
$18 an hourTemporaryExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
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The Advanced Practice Practitioner (APP) will be an integral member of the care delivery team, including ED and Hospitalist Physicians and APP providers, nurses, PT, OT, Imaging, cardiology, neurology, psychiatry, case management and utilization review.
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Works closely with hospital Case Management, Scheduling, Utilization Review, Health Information Management, Patient Financial Services, Referral/Prior Authorization, Hospital/Clinic Operations, and clinical service departments to ensure effective patient access operations both inter- and intra-departmentally.
$75,000 - $100,000ExpandApply NowActive JobUpdated 3 days ago
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