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Knowledge of clinic operations, utilization review, quality management, patient billing, accounting, budgeting and financial reporting, government and private grant management, public health issues and concerns required.
$102,856 - $139,678.22 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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St. Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Surgical, Orthopedics, Maternal-Child Health, Behavioral Health and Emergency and Trauma Care.
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Performs drug utilization review, comprehensive medication review, and/or medication reconciliation. Given a diagnosis, synthesize a treatment plan, which may include drug therapy and lifestyle modifications, and transition within the continuum of care settings.
$91.76 - $94.51 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization requests from all lines of business using respective national/state, health plan, nationally recognized guidelines.
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The role reflects appropriate knowledge of RN scope of practice, current state requirements, CMS Conditions of Participation, EMTALA, The Patient Bill of Rights, AB1203 and other Federal or State regulatory agency requirements specific to Utilization Review and Discharge Planning.
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Duties and responsibilitiesConducts pre-certification, out of network and appropriateness of treatment setting reviews within scope of licensure by utilizing appropriate medical policies and clinical guidelines in compliance with department guidelines and consistent with the members eligibility, benefits and contract.
$65,000 - $80,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Demonstrates an understanding of the patient's clinical condition, social, and financial resources to determine the most appropriate care setting, practice standards for evaluation, treatment delivery options (Home, SAR, SNF, LTACH, Acute Rehabilitation, Assisted Living, Board/Care, Recuperative Care, Shelter), and resources required to support safe transition of care.
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Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency with coverage guidelines. Current valid License as a Licensed Vocational Nurse.
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Participates in utilization review, consultations and case management. Assures quality treatment services and a safe environment for clients and staff by ensuring compliance with policies, procedures, standards, rules Joint Commission requirements and legal regulations.
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The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.
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Participate in patient care planning and utilization review meetings. Provides professional treatment while using therapeutic techniques for the rehabilitation of patients with speech, language, hearing, oral motor, swallowing and cognitive disorders.
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Conducts precertification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
$80,868 - $121,302 a yearFull-timeExpandApply NowActive JobUpdated 8 days ago
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