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The RN Care Coordinator consistently conducts the utilization review process and the discharge planning process as required by hospital policies standards of practice and Federal and State regulations.
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Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.
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The position allocated to this class is responsible for directing, through subordinate supervisors, the activities of the Utilization Review Nurses engaged in utilization review activities, in accordance with the Professional Standards Review Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard.
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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.
$2,480ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The RN Care Coordinator is responsible for assessing planning facilitating and advocating for options and services through a continuum of care from point of contact through discharge on assigned patients.
$50.33 - $68.35 an hourPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
$49,200 - $70,300 a yearWork from homeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Performs daily concurrent review, retro reviews, ER reviews, discharge planning, pre-certification/prior authorization request review and ensures patients meet appropriate level of care based on acceptable evidenced based practices.
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Minimum 1 year of case management or utilization review experience required. Complete concurrent review in Meditech daily on insurance, non-funded & MediCal patients, every other day for Medicare patients.
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In collaboration with the AVP for Student Affairs and Wellness, continually review and adapt the counseling service model to ensure student access to a broad range of interventions and modalities (e.g., stepped care, group therapy, peer support) while optimizing the utilization of clinical resources.
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You will also perform utilization review while assuring the delivery of concurrent and post-hospital care. Recent experience in case management, utilization management and discharge planning.
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Day-to-day They will be responsible for complete inpatient hospital setting case management in acute care looking after Utilization review , Discharge planning of the inpatient. This is Utilization Management, Care without Delay, Long Term Care, Home Care, Bed Control Center team overlooking Fontana Medical Center and Ontario Medical Center in San Bernardino County.
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Experience in Quality Improvement/Utilization Review/Clinical Records Programs in a hospital or mental health setting preferred. Serve as a resource for staff implementation of departmental Quality Management and Utilization Review.
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Preferred Qualifications: Bachelor's degree Nursing 1 year Case management or utilization review experience within the last three years preferred. The RN case manager role integrates the functions of utilization management, quality management, discharge planning assessment, and coordination of post-hospital care services, including transfers to an alternative level of care.
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To include at least two years' experience in nursing or one-year related nursing experience in utilization review/insurance/case management/medical clearance. Two years' experience in utilization review with external payors within a hospital or insurance setting.
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The UR Case Manager follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review. Job Summary: Key Job ResponsibilitiesThe Utilization Review Case Manager validates the patient's placement to be at the most appropriate level of care based on nationally accepted admission criteria.
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utilization review jobs in Glendale, CA
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