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During this individual supervision a chart review should be completed using the updated Utilization Review sheet with particular attention paid to whether or not a PGP exists to cover the time period since the last CBH review.
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The Transitional Care Manager will be is responsible for a broad range of skills, clinical expertise and proficiency in complex case management, utilization review, and care coordinator of at-risk members during admission and set-up transition plans post discharge 7-14 days from an inpatient facility.
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Monogram’s innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum.
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The primary responsibilities are to perform selected services and functions related to patient care coordination, utilization review, discharge planning and data collection for the Case Management Department.
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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 Weekly payment estimates are intended for informational purposes only and include a gross estimate of hourly wages and reimbursements for meal, incidental, and housing expenses.
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The Case Manager performs daily utilization review and conveys pertinent telephonic information to third party payers to secure appropriate acute care reimbursement within the time requirements of the payer.
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Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
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Responsibilities include the reporting the financial impact of current Utilization review appeals as well as the financial impact of post review audits. These responsibilities include a complete understanding of the Epic Revenue System as well as Cobius Audit Manager and Siemen Invision.
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Ensure the accuracy and appropriateness of all prescriptions filled by completing Drug Utilization Review and Final Quality Assurance, applicable to state and federal Board of Pharmacy regulations.
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Experience in discharge planning or utilization review specialty area is preferred. Position Summary: Review of medical charts in order to justify appropriate billing to insurance companies for inpatient or observation services.
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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.
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Facilitate intake, admission and utilization review process for incoming patients. Provide accurate and ongoing assessment of patient’s status in the admissions, intake and utilization process.
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Perform utilization review determinations for radiation oncology populations, and support case and disease management teams to achieve optimal clinical outcomes. Demonstrated accomplishments in the areas of medical care delivery systems, utilization management, case management, disease management, quality management, product development and/or peer review.
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Key responsibilities include overseeing fleet maintenance, cost management, vendor negotiations, and regulatory compliance, as well as developing strategies for optimal fleet utilization. Invoice Approval: Review and approve invoices related to fleet maintenance and repairs, ensuring accuracy and compliance with budgetary guidelines.
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The Case Manager performs ongoing PI/QA during concurrent review to identify quality of care issues, risk management issues, and performs blood/blood products and medication utilization.
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utilization review jobs in Philadelphia, PA
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