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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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A minimum of two (2) years quality/utilization review experience in an HMO, managed care organization, or similar experience as a hospital inpatient coder or auditor required. CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRX Services, LLC.
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The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions.
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Interact with insurance companies for pre-certification and utilization management. ounselor, social worker, marrage and family therapist, inpatient, counseling, therapy, LMHC, registered, behavioral health professional, LPCC, LPC, LMFT, MFT, QMHA,licensed.
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06 As a Utilization Review Coordinator, you will manage and analyze mental health service data from our electronic health record (EHR) Credible. Please speak to your experience with data review and analysis as well as your experience working with electronic health records.
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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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As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team. Utilization review, prior authorization, Care management, Case management, interqual, ncqa, ncqa standards.
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Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, or Utilization Review Coordinator). The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed.
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Job Overview: The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies. The Utilization Review Specialist provides appropriate client information to third party payers regarding the medical necessity of treatment in a timely manner.
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Prior Utilization Review experience in a Substance abuse environment is mandatory. Job DescriptionJob DescriptionUtilization Review Specialist/Behavioral Health Substance AbuseFLSA Status: ExemptClassification: Full-Time Reports To: The UR Specialist will report to UR Manager.
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The Utilization Review LVN uses clinical judgement in providing utilization management services. - Preferred 5-7 years of experience in combination of utilization management prior authorization or acute/sub-acute care experience.
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Provides Utilization Management activities and functions by using MTF-specific Quality Improvement processes to identify areas for review from data, suspected problem areas, and input from departments/services within the facility.
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Administrative practices and procedures including but not limited to quality assessment and improvement, care coordination, utilization review, peer review, credentialing and risk management.
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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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Active California Counseling License Required (e.g., LPCC, LCPC, LCMHC, LMHC, LCSW). Maintaining production goals and QA standards, this position ensures the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process with the California Mental Health Services Authority (CalMHSA.
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utilization management lmhc review jobs Company: Metroplus Health Plan
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