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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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The Utilization Review coordinator performs activities which support the Utilization Management functions. We are Hiring at UofL Health Utilization Review Coordinators.
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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. BSN Degree from an accredited nursing program or proven success as Registered Nurse Utilization Review I role.
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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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Three to Five years experience in case management or utilization review or proven success as Registered Nurse Utilization Review I role. 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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VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Manhattan, New York. Specialty: Utilization Review. 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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Participate in quality assurance and utilization review. LPCC's/LCSW's may be required to supervise LPCA's/CSW's and other associates under supervision. LICENSURE IS REQUIRED (LPCC, LPCA, CSW, LCSW, etc.
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Works with the Utilization Manager, Transitional Navigator, and other program staff to coordinate Crisis Intervention Services’ Utilization Review process. Certified by the Office of Mental Health (OMH) as a Certified Peer Specialist or Office of Alcoholism and Substance Abuse (OASAS) as a Certified Peer Recovery Advocate or willingness to become certified within six months of hire is preferredA respect for and high level of comfort around people experiencing psychiatric crisis.
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When naviHealth is delegated for utilization management, review referral requests that cannot be approved for continued stay and are forward to licensed physicians for review and issuance of the NOMNC when appropriate.
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Utilization Review in Medicare NOMNC/ABN Letters, Medicare Certifications, hospital referral review, evaluation of hospital records for ICD10 coding, setting of ARD dates, etc., of admissions and readmissions, OBRA scheduling, Part B Authorization as needed, CMI Picture Date.
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Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Group Health and Workers’ Compensation and other Casualty clients. Provides case management, utilization review, continued stay reviews, and based on clinical judgment and state WCB Medical Treatment Guidelines.
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Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: ASAP Duration: Ongoing Employment Type: Staff Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health.
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The Utilization Review Specialist is responsible for utilization management according to URAC-approved clinically valid criteria, ensuring compliance with regulatory standards and meeting daily deadlines to obtain authorizations and complete other pertinent processes.
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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. 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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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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review utilization jobs Title: associate Company: Statejobsny
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