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3 years of hospital-based Case Management experience including Utilization Review and Discharge Planning experience. Coordinates and participates in hospital utilization review process.
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Assists RN Circulator to ensure proper room utilization through decreased turnover time per CPT and scheduled procedural time review. Please review the. Demonstrates prudence in par level supplies and utilization.
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Two years experience in Utilization Review, Utilization Management or Case Management preferred. Job Description: To achieve quality healthcare outcomes by establishing a safe, individualized discharge and providing proficient timely utilization management services to ensure that maximum reimbursement is achieved for all patient visits.
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Equivalent to a Bachelor's Degree in nursing, management, business administration or related field and five (5) years of clinical nursing experience, or utilization review/case management experience, three (3) years of which were in a supervisory/managerial role.
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Interprets and applies coverage and payment policies, standards of care, and/or utilization review criteria, as applicable to specific position. Individuals with a degree in a healthcare related field who possess professional clinical backgrounds with Medicare QIO experience with quality of care reviews or in performing medical reviews in support of MAC or RAC appeals, pre- and post-pay claims reviews, and utilization reviews may also qualify.
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Job Summary The Clinical Education Consultant provides customers with clinical, functional, and operational expertise in the following areas: educational and systems development consulting, product line utilization management and services, and clinical sales-related support to the Account Executives and Sales Management.
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Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers’ compensation claims.
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Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services.
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Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting a utilization review or an appeals consideration and cannot be located on a US military base, vessel, or any embassy located in or outside of the US.
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Working knowledge of laws, rules, and regulations regarding utilization review and discharge planning functions of government programs such Medicare, Medi-Cal, and CCS. Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Clinical Documentation Specialist.
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Proven knowledge of Utilization review and MCG. Proven knowledge of Utilization review and MCG. Member education, medication reconciliation and benefit management. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life.
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Participation in Quarterly Clinical Utilization Review Meetings: You will participate in quarterly clinical utilization review meetings to ensure that the organization is providing high-quality, cost-effective care to its patients.
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Utilization Review: The process of measuring and assessing the use of professional care, services, procedures, and facilities, including the medical necessity and appropriateness of setting, using evidence based criteria.
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Do you have at least five (5) years of clinical nursing/utilization review/case management experience, and three (3) years in progressing leadership positions? Actively provides support and leadership to collaborative discharge planning and utilization review processes.
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Starting with Valley Hospital Medical Center in 1979, the Valley Health System has grown to include Centennial Hills Hospital Medical Center, Spring Valley Hospital Medical Center, Summerlin Hospital Medical Center,Henderson Hospital and Valley Health Specialty Hospital.
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utilization review jobs in Las Vegas, NV
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