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Description Summary: The RN Utilization Review II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services.
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Assist the Grievance and Appeals Department in completing clinical appeals case summaries for submission to the Independent Review Entity, State Hearings and other escalated appeals.
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Leads Tenet Hospital case management operations to develop and implement centralized utilization review and authorization management services by market or region to promote an appropriate level of care and prevent payer denials.
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Work Experience : 3 years RN experience in an acute care setting; Leadership experience preferred; Utilization review, discharge planning or case management experience preferred. Licensure/Registration/Certification: NYS Licensure as RN required; LMSW /LCSW preferred; Case management certification preferred.
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UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends. Must possess strong critical thinking skills, have an ability to perform clinical/chart review and abstract information efficiently.
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MCCFL offers a variety of programs including a mobile crisis unit, intensive case management, ongoing counseling, community support, supported employment, jail diversion, hospital discharges, hearings, and more.
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Case Management: Provide case management, advocacy-based counseling, information, referrals, and follow up information to emergency shelter and transitional housing program reside Work with residents to review individual goals and ongoing progress.
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INTEGRIS Health Baptist Medical Center, Oklahomas largest not-for-profit health system has a great opportunity for a RN Case Manager in Oklahoma City, OK. In this position, youll work 8a-4p, Part-time, with our Case Management team providing exceptional care to those who have entrusted INTEGRIS Health with their healthcare needs.
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Key Words: RN Travel, Travel Nurse, Contract Nurse, Agency Nurse, Travel Contract, Travel Nursing, Case Manager, Case Management, Utilization Review, Case Manager RN.
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MedPro Healthcare Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Washington, District of Columbia. The role of the case management nurse (RN) is to coordinate continuity of care for patients often as a liaison between the patients family and healthcare organization.
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MedPro Healthcare Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Irving, Texas. Work is administered in a variety of settings, including HMOs, community health organizations, long-term care facilities, behavioral health programs, rehabilitation centers, schools, and case management companies.
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The goals of Case Management include the achievement of optimal health, access to services, advocacy, appropriate utilization of resources, collaboration with post-acute care providers to ensure patient's needs are met in the community, and to provide timely clinical reviews to payers.
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Understanding in single case processing, aggregate data review and evaluation of drug safety issues, adverse event dictionaries, literature publications, core labeling, and Periodic Safety Review preparation is required.
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Assure that all Pay 4 Performance criteria are being met: The Blended Case Management Supervisor is responsible for assuring that the staff under their supervision are making every attempt to complete the documentation in a timely fashion and that it meets the general guidelines of legibility, it is signed, dated and that the content follows the DAP format and explains the nature of the contact.
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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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review case management jobs Title: clinical manager Company: Humana
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