team, complex case management and disease management. The UM RN will work closely with the Medical Directors and refer... for extension of these services and if not meeting criteria, refer to the Medical Director. 3. Participates in Community Nursing...
team, complex case management and disease management. The UM RN will work closely with the Medical Directors and refer... for extension of these services and if not meeting criteria, refer to the Medical Director. 3. Participates in Community Nursing...
team, complex case management and disease management. The UM RN will work closely with the Medical Directors and refer... for extension of these services and if not meeting criteria, refer to the Medical Director. 3. Participates in Community Nursing...
Care Reviewer – Utilization Management evaluates medical necessity for inpatient and outpatient services, ensuring..., and ensures compliance with medical policies. When necessary, cases are escalated to the Medical Director for further review. The...
as needed with the utilization management physician advisors and/or medical directors on problematic cases and documents his decisions...Job Category: Revenue_Cycle Job Description: Under broad direction from the Centralized Utilization Management...
Job Category: Revenue_Cycle Job Description: Under broad direction from the Sr. Director of Utilization Management... Management measures. e. Collaborates with the Sr. Director of Utilization Management to analyze and maintain key performance...
) Utilization Management (UM) team performs prospective, concurrent, retrospective utilization reviews and first level... across multiple lines of business. The Behavioral Health Utilization Management, Consultant (Lead), will report to the Manager...
Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC... Behavioral Health Utilization Management Clinician, Experienced, will report to the Manager of Behavioral Health Utilization...
Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC... Behavioral Health Utilization Management Clinician, Senior, will report to the Manager of Behavioral Health Utilization...
Utilization Management (UM) team, maintaining effective and efficient processes for determining appropriate patient admission... regulatory requirements for Utilization Management. Attends Mandatory Education programs required by the organization. Keeps...
Job Description: PRINCIPAL RESPONSIBILITIES: The Inpatient Utilization Management (UM) RN is responsible... Alliance Medical Director to validate patient acuity and plan of care; Extrapolate and summarizes medical information...
alongside the Director of Resource Management as a coach and mentor to the staff, leading by example. The Utilization Review..., coordinating, monitoring and evaluating), utilization management, utilization review, or healthcare decision support with the...
Overview: Under the supervision of Director of Utilization or designee – the Utilization Management RN is responsible... for concurrent reviews. The Utilization Management RN will work in conjunction with Case Managers, Social Workers, Physicians, care...
, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer... Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices...
orientated medical chart reviews and other administrative tasks to meet the requirements of the medical center's utilization... of case management or utilization management experience required. Knowledge of InterQual or McKesson criteria preferred...
orientated medical chart reviews and other administrative tasks to meet the requirements of the medical center's utilization... of case management or utilization management experience required. Knowledge of InterQual or McKesson criteria preferred...
as needed to measure and trend performance indicators identified in the Utilization/Medical Management Plan. Ensures the management... of utilization management activities Oversees the management of observation cases, both concurrently and retrospectively...
for our community and for each other every day. Position Summary: The Utilization Management Nurse is responsible for a comprehensive... with all regulatory requirements. Work collaboratively with the Physician Advisor and Medicare Director of Care management in determining...
criteria, and regulatory requirements. 2. Collaboration with Medical Director Review and escalate complex or borderline... cases to the Medical Director for further assessment. Provide the Medical Director with comprehensive clinical summaries...
criteria, and regulatory requirements. 2. Collaboration with Medical Director Review and escalate complex or borderline... cases to the Medical Director for further assessment. Provide the Medical Director with comprehensive clinical summaries...