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O Ensures updates and maintenance of hospital plans is completed (for example Plan for the Provision of Care/Scope of Services, Leadership, Information Management, Utilization Review, Infection Control, Performance Improvement and Patient Safety.
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Facilitates the utilization of resources to meet patient outcomes and contribute to Facility (AMC), New York State and National Quality data metrics. Performs review and triage of incoming test results, patient requests and pharmacy renewals; facilitates call-backs to patients as necessary.
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Utilization and application of scientific knowledge and techniques for data review activities supporting potency and bioassays. Review of logbook and lab notebooks for accuracy and completion.
Full-timeExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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While performing utilization review identifies areas for clinical documentation improvement and contacts appropriate department. Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies.
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Experience in skilled nursing facilities, clinical reimbursement, concurrent review and/or utilization management is desirable. Review clinical documentation to define expectations, criteria, and variables that will impact the care plan and outcomes.
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Conduct budget variance and forecasting analysis, with an 80% focus on Excel for creating detailed financial reports and a 20% utilization of Oracle EBS for data verification and extraction. Oversee monthly financial review processes, utilizing Excel for data compilation and presentation, and Oracle EBS for systematized data input.
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Preferred Qualifications: The ideal Candidate will have professional skills including nursing surveillance, clinical skills, excellent writing and editing skills, and proficiency navigating computer applications used for surveillance or utilization review, SharePoint, and the Electronic Plan of Correction system, and has the ability to expeditiously and effectively interpret laws and regulations governing adult care and assisted living facilities in New York State.
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As a Medical Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination reviews and reviews of claim determinations. This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.
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Eurofins is one of the market leaders in certain testing and laboratory services for genomics, discovery pharmacology, forensics, advanced material sciences and in the support of clinical studies, as well as having an emerging global presence in Contract Development and Manufacturing Organisations.
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Responsibilities:The Clinical Pre-Admission Facilitator is responsible for patient assessment for acute rehabilitation based on established criteria of the acute rehabilitation center and with compliance to CMS of clients, family members, referral sources, and external payers regarding the effective and efficient utilization of program services and available resources.
$31.5 - $43.28 an hourFull-timeExpandApply NowActive JobUpdated 2 months ago - UpvoteDownvoteShare Job
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Oversee and make decisions related to performance of fabrication shop work and review jobsite needs with project staff for logistics, organization, plant layout, equipment, quality control, and workforce utilization.
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A minimum of two (2) years quality/utilization review experience in an HMO, managed care organization, or similar experience as a hospital inpatient coder or auditor required. The Clinical Review and Coding Nurse is responsible to attain procedure and diagnosis coding accuracy and consistency on referred cases.
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The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. Minimum of two (2) years Utilization Management experience is preferred.
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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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This job captures all inbound requests for utilization review from providers and pharmacies. The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review.
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utilization review jobs in Troy, NY
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