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The Utilization Review Nurse performs prospective and retrospective reviews for post-acute care services. The Utilization Review Nurse will comply with all standard operating procedures, and all departmental and organizational policies.
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InterQual Certified Instruction (IQCI), Accredited Case Manager (ACM) or Certified Public Accountant (CPA) preferred, Six Sigma Green Belt preferred. Lead Tenet Utilization Review Teams market structure and operations management to effectively support utilization review and authorization confirmation functions to promote an appropriate level of care and prevent payer denials.
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The RN Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS. CHRISTUS Santa Rosa Hospital - Westover Hills (CSRH-WH) is a 150-bed hospital serving the fastest growing area of San Antonio.
Full-timeExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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About You The Client Success Manager needs to be proactive, a relationship builder, and must be comfortable ensuring a customer's business objectives are achieved through the full utilization of multiple products by end users.
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The Workers' Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and at times, attorneys to support the appropriate return to work, the provision of necessary medical services, and the evaluation of coverage under the Plan. The Nurse Case Manager reports to the Casualty Department Manager.
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Provides utilization management, clinical documentation integrity, discharge planning and post-acute care needs assessment and acts as a liaison for utilization management and clinical documentation improvement.
$22 an hourPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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On issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care coordination. The Social Work Care Manager, in collaboration with the patient/family, care manager nurses, nurses, physicians and the.
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With TPMG partner, directs development and implementation of quality and utilization standards across the continuum of care to ensure coordinated plans of treatment, patient focused delivery of services and cost effective utilization of necessary services.
$196,000 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Utilization of EPIC EMR with Dragon. Advanced diagnostic tools including MRI, CAT Scan, Ultrasound, Cath Lab, Anesthesia (in-house), and Nuclear Medicine with radiology reports available 24/7.
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Outstanding full-time support including physician(s), RNs, and x-ray tech. On-site x-ray, ultrasound, and lab services. Short-term Disability & Long-term Disability Insurance (UNUM). Paid Continuing Medical Education (CME.
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Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred. Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
$70.68 an hourExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Intus Care is seeking a dynamic and experienced Population Health Nurse with utilization management experience. Coordinate Claim Disputes - In cases of claim rejection, the Intus Care Utilization Management Nurse will lead the provider dispute process.
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Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and/or case management is highly desirable. The RN / MDS COORDINATOR manages the overall process and tracking of all Medicare/Medicaid case-mix documents to ensure appropriate reimbursement for all services provided within the nursing.
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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. MedPro Healthcare Staffing , a Joint Commission-certified staffing agency, is seeking a quality Case Manager Registered Nurse (RN) for a travel assignment with one of our top healthcare clients.
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Eighteen months of recent experience in an Acute Care Case Manager setting. Posted job title: Case Manager Registered Nurse Nursing: Case Manager. MedPro Healthcare Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Irving, Texas.
$1,188 a weekExpandApply NowActive JobUpdated Today
manager utilization jobs Company: Metroplus Health Plan
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