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The Utilization Management Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS. The Utilization Management Nurse III is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services.
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The Utilization Review RN is responsible for the delivery of the Utilization Management process not limited to and including: 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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Experienced/career level position responsible for overseeing quality review audits of medical records coded by internal team (CDQA and Sr Analyst CDQA) to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.
$67,900 - $149,300 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Officially we title this job a BOM or Business Office Manager, but in other centers it may be called a Medicare / Medicaid Biller or Accounts Receivable Coordinator or even a Financial Services Rep. What’s in it for you: Our patients are loud, happy and eager to say hello to you as you pass by.
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Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator.
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Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required.
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Utilization Management Medicare Advantage Post-Acute Care RN. Two (2) to four (4) years of clinical experience which may include post-acute care, home care, acute patient care, discharge planning, case management, and utilization review, and caring for aging population in the home or post-acute care setting, etc.
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Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. About Presbyterian Healthcare Services.
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The Audit and Reimbursement III will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services.
$62,400 - $98,280 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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In-depth knowledge of healthcare laws and regulations, with specific expertise in compliance requirements related to billing and coding, privacy and security, and fraud, waste and abuse, including but not limited to HIPAA, Anti-Kickback, Stark, Medicare/Medicaid reimbursement.
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Coordinates, identifies, and/or initiates significant change MDS'Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management CoordinatorQualifications:Registered Nurse, RNKnowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred.
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Oversee strategic product initiatives related to value-based care program management, ensuring that service offerings comply with Centers for Medicare and Medicaid Services (“CMS”) rulemaking and other applicable guidelines.
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We CARE for our patients like they are our own FAMILY. Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), require COVID-19 vaccinations for all Medicare and Medicaid certified providers.
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Demonstrated understanding of insurance, Medicaid, Medicare billing requirements. Current, active, and unencumbered WV State License as a Licensed Independent Clinical Social Worker (LICSW), Licensed Mental Health Counselor (LMHC) or Licensed Marriage and Family Therapist (LMFT.
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Current, active, and unencumbered MA State License as a Licensed Independent Clinical Social Worker (LICSW), Licensed Mental Health Counselor (LMHC) or Licensed Marriage and Family Therapist (LMFT). State License with one or more of the following licenses: Licensed Independent Clinical Social Worker (LICSW), Licensed Mental Health Counselor (LMHC) or Licensed Marriage and Family Therapist (LMFT.
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medicare medicaid utilization management jobs Company: Presbyterian Healthcare Services
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