Care Reviewer – Utilization Management evaluates medical necessity for inpatient and outpatient services, ensuring.... The Clinical Care Reviewer – Utilization Management will also be counted upon to: Conduct concurrent reviews by assessing...
case management, utilization review, social work, discharge planning, readmission reduction, and transitions of care... performance. 7. Ensure department practices are aligned with CMS, Joint Commission, and payer requirements for utilization review...
in Utilization Review Experience: To view a full list of all open position at Bayhealth, please visit:... RANGE: 87,089.60 - 134,992.00YEARLY General Summary: Plans, organizes, and implements care management functions for BHMC. Provide supervision of all the Care...
with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes - Medical/Utilization Review experience..., and pharmacology. - Clinical practice guidelines. - Utilization review standards and practices. - State-specific workers...
. - Work on special projects as assigned. - Other duties as assigned by management. Minimum Requirements - Current Nurse... coverage guidelines. - Anatomy, physiology, and pharmacology. - Clinical practice guidelines. - Utilization review...