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The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed. Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, or Utilization Review Coordinator.
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The University of Colorado Anschutz Medical Campus is seeking a Medicaid Utilization Review Specialist (full time, University Staff/Non classified) in the Department of Psychiatry. Job Title: Clinical Utilization Review Specialist.
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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 Nurse provides clinical review for different healthcare services requiring authorization- including acute inpatient, skilled nursing facility, acute rehab, home nursing as well as others.
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JOB SUMMARYThe RN Utilization Review coordinates care for OPIS patients who are high cost, complex, and at risk. · Review medical records for knowledge/understanding of situation and resource assessment.
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Monitor costs, avoidable treatments and resource utilization. Maintains understanding of various payers and Medicare pre-authorization processes. Serves as a liaison between hospital and payer to obtain pre-authorization confirmation and enters into medical record/billing system timely and accurately.
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Communicates with physicians to ensure that correct clinical data is documented to gain proper pre-authorization for third party payers. NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.
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Understands the legal/regulatory requirements related to the release of information. Licensed as a Registered Nurse (RN) in the State of Florida · Minimum of 1 year of experience in a related field required.
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Makes referrals to the Case Manager of compassion drug program as appropriate. Works with business office to resolve payment denials. Participates in focused studies to resolve patterns in aggregate variances.
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Utilization Review RN. Reviews, assesses, and evaluates clinical information used to support Utilization Management (UM) decisions based on established clinical criteria and applies intermediate knowledge of coding and medical record research.
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Actively looking to hire multiple RNs to join a growing managed care organization on a Sunday to Thursday OR Tuesday to Saturday basis doing utilization review for PAC patients. Experienced in Utilization Management and knowledge of URAC & NCQA standards.
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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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RequirementsTo be considered for the Utilization Review Specialist position, you will need:Master's degree from an accredited college or university in social work, mental health, nursing, or related degree Required.
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Under general supervision, the purpose of the position is to coordinate and participate in the TRC process within the Development Review Department in coordination with other departments, including representation of TRC, PC, and BCC levels.
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Review graphics/art department deliverables as to quality and adherence to storyboard dictates. Review and edit course scripts, descriptions, storyboards, and other deliverables. Provide quality control review of web-based content.
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Title: utilization review Company: Waukegan Hospital
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