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Assist the Grievance and Appeals Department in completing clinical appeals case summaries for submission to the Independent Review Entity, State Hearings and other escalated appeals.
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Leads Tenet Hospital case management operations to develop and implement centralized utilization review and authorization management services by market or region to promote an appropriate level of care and prevent payer denials.
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What You'll Be Doing: As a Physician Clinical Reviewer, Interventional Pain Management, you will be a key member of the utilization management team. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
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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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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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The Utilization Review Specialist manages daily operations, which include supervising the staff performing benefit enrollments and utilization management activities. The Utilization Review Specialist review functions as the internal resource on issues related to the appropriate utilization of resources & services, coordination of care across agency and utilization review and management.
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This leader plans, organizes, directs, and evaluates resource and quality management services, departments, and programs, such as Quality Assurance, Utilization Review, Infection Control, Case Management, and Admissions.
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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.
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The Case Management Assistant (CMA) will work under the direction of the RN case manager or social worker to assist with facilitating patient discharges requiring post-acute placement or services, and will identify and report barriers to discharges.
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Follows all cases throughout the duration of the admission, working with Utilization Review (UR) Department every few days in Ontrac to send concurrent review clinicals. Determines eligibility for admission/treatment in compliance with hospital policy, utilization review criteria, and State and Federal regulations and/or guidelines.
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Coordinate case management on complex cases that require additional clinical management support. As a Utilization Management Nurse at Aspire Health Plan, you will make sure our health services are administered efficiently and effectively.
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Summary: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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The Utilization Review Specialist participates in department development and unit performance improvement. The Utilization Review Specialist coordinates the design, development, implementation, and monitoring of the organizations Benefits and utilization review functions.
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MedPro Healthcare Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Lansing, Michigan. The role of the case management nurse (RN) is to coordinate continuity of care for patients often as a liaison between the patients family and healthcare organization.
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License, Certification, Registration Registered Nurse License (California) Basic Life Support Additional Requirements: Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning or case management.
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full time case management utilization review jobs Title: clinical social worker in Anoka, Minnesota
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