Network Will promptly report any issues with the database and/or programs Review patient records daily to assess... level review as appropriate Monitor patient status in Epic and in Case Advisor, escalating patient records that require...
Network Will promptly report any issues with the database and/or programs Review patient records daily to assess... level review as appropriate Monitor patient status in Epic and in Case Advisor, escalating patient records that require...
review or other activities. Reviews, analyses and identifies utilization patterns and trends, problems or inappropriate... interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning...
, bending, and climbing. May lift, carry, push and pull up to 5 pounds. JOB SUMMARY The Utilization Review Expert Nurse...
identified during the utilization review process to department leaders. b. Notifies physicians of need for additional...Job Category: Revenue_Cycle Job Description: Under broad direction from the Centralized Utilization Management...
to outpatient and inpatient, utilization management operations, including but not limited to prior authorization, concurrent review...Responsibilities Utilization Management: Oversees all administrative, operational and clinical functions related...
. *Performs utilization review activities, including concurrent and retrospective reviews as required. 3. *Determines the...GENERAL SUMMARY: Conducts day-to-day activities for the clinical, financial and utilization coordination of the...
. *Performs utilization review activities, including concurrent and retrospective reviews as required. 3. *Determines the...GENERAL SUMMARY: Conducts day-to-day activities for the clinical, financial and utilization coordination of the...
JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential... RESPONSIBILITIES: Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute services when...
JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential... RESPONSIBILITIES: Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute services when...
effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the... Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred. 3. Five years acute care nursing...
Review Specialist-RN provides consultative services regarding quality assessment and trends to medical staff and to hospital...; 2 Years of experience in quality or utilization review. Substitutable Education & Experience (Optional): None...
as an RN in utilization management *All employees working remotely will be required to adhere to UnitedHealth Group... is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial) -Validate that cases/requests for services...
Duties and Responsibilities: Performs inpatient utilization management activities as determined by the utilization... of an accredited school of nursing required. Current RN License in the State of Illinois required. Two years of relevant...
as an RN in utilization management *All employees working remotely will be required to adhere to UnitedHealth Group... is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial) -Validate that cases/requests for services...
Medical Review RN / Nurse Specialist II Work from Home within the Continental United States @Orchard LLC..., utilization review, managed care organization quality review, and quality assurance for programs serving individuals...
Medical Review RN / Nurse Specialist II Work from Home within the Continental United States @Orchard LLC..., utilization review, managed care organization quality review, and quality assurance for programs serving individuals...
, teach and collaborate with others. Excellent critical thinking skills related to nursing utilization review Knowledge... but saving them. Together. The Inpatient Review Nurse assists patients through the continuum of care in collaboration with the...
Overview: Medicare Medical Review RN (Medical Reviewer III) - REMOTE The Medicare Medical Review RN (Medical... of medical terminology and experience in the analysis and processing of Medicare claims, utilization review/ quality assurance...
role The Pre-Certification Review Nurse - Pharmacy is responsible for reviewing and processing coverage determinations... and utilization management reviews for specialty medications, to include site of care assessments, for enrollees of Quantum Health...