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The Utilization Review RN utilizes his/her skills to coordinate internal and external resources to facilitate appropriate resource management of an age specific patient population which spans from newborns to geriatrics, identifying opportunities for process improvement, high risk cases and sentinel events, to the achievement of an acceptable outcome.
$35.43 - $52.44 an hourPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Job Summary:The Utilization Review Specialist is responsible for the pre-certification, concurrent, and discharge review process for clients at all levels of care, resulting in the approval of their admission and continued treatment.
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In collaboration with providers and the Medical Director, the Utilization Review Nurse ensures medical appropriateness and effective utilization of health care resources. The Utilization Review Nurse ensures that authorization requests and provider or member inquiries are handled appropriately within established timeframes, and established guidelines and protocols are utilized for clinical decision-making.
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Licensed to practice medicine in the State of Texas and ten (10) years of progressive management/leadership and patient care experience, practice experience in Telemedicine, Electronic Utilization Review, and Quality Improvement is desirable.
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Utilization Management: Oversee utilization review processes to ensure appropriate and efficient use of healthcare resources. This involves overseeing and promoting the proper utilization of tools such as chronic care management, transitional care management, advanced care planning, cognitive behavior screening, laboratory tests, X-rays, and other screening tools.
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The Utilization Review Specialist will work as a part of the multi-disciplinary team (MDT) and is responsible for maintaining standards of care and competency, ethical treatment of patients, understanding of addiction and the medications used for detoxification purposes, managing symptoms of withdrawal with comprehensive triage, consistent documentation on care, review and implementation of treatment orders.
$19.25 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Utilization Review coordinator performs activities which support the Utilization Management functions. We are Hiring Utilization Review Coordinators! They are responsible for the delivery of the Utilization Management process including but not limited to: making clinical recommendations regarding medical necessity for admission and continues stay, screens patients for client specific guidelines regarding insurance, Medicare and/or Medicaid guidelines, send payor specific Notice of Admission and continued stay reviews.
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If you're an experienced clinician looking to forge a new career path where your clinical knowledge is valued, consider our Utilization Review Specialist position. As a Utilization Review Specialist, you will play a pivotal role in ensuring the efficient and effective utilization of healthcare resources.
Full-timeExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends. Position Summary: Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information.
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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.
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Participate in leadership team by actively contributing in decision making, grievance follow up, building and company-wide initiatives and attending leadership team meetings such as stand up, Managing Acute Care Conditions (MACC), Nutrition at Risk (NAR), Utilization Review (UR), Quality Assurance Performance Improvement (QAPI) and other meetings as required.
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Attend and/or participate in facility meetings as directed by the center manager (may include utilization review, infection control, disaster preparedness, etc.) Throughout the country we operate primarily as NovaCare Rehabilitation, Select Physical Therapy, Champion Sports Medicine, Banner, Physio, RUSH, Kessler Rehabilitation Center, KORT, Saco Bay Physical Therapy, Concentra, SSM Physical Therapy and Keystone Physical Therapy.
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Monograms innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum.
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Relevant experience includes previous industry, utilization management/utilization review experience and care coordination. This roles supports the Utilization Medical Policy Committee and creates New Technology policies for committee review.
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Oversee refuse being received; ensure proper handling; supervise and monitor all required testing, including sampling of monitoring wells; monitors utilization of cover material; review soil reports and provide information to Environmental Manager.
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