admitting system Key Responsibilities Perform admission, concurrent, and post-discharge utilization reviews in accordance.... Review and route denial notifications for appeal consideration; collaborate with post-denials, RAC, and appeal teams...
. This position provides inpatient care coordination and concurrent review services for identified hospitalized medical / surgical... transitions in levels of care. ACCOUNTABILITIES: Provide on-site and/or telephonic inpatient case management and concurrent...
. This position provides inpatient care coordination and concurrent review services for identified hospitalized medical / surgical... transitions in levels of care. ACCOUNTABILITIES: Provide on-site and/or telephonic inpatient case management and concurrent...
. This position provides inpatient care coordination and concurrent review services for identified hospitalized medical / surgical... transitions in levels of care. ACCOUNTABILITIES: Provide on-site and/or telephonic inpatient case management and concurrent...
. In addition, assists with denial management of cases denied both concurrently and retrospectively. Status available: Part-time... of Michigan Registered Nurse License. Three years acute care experience as a Registered Nurse or five years demonstrated...
procedures that do not require the training or skill of a registered nurse. How you'll make a difference: Confirms medical... less complex benefit plans and/or contracts. Conducts and may approve precertification, concurrent, retrospective, out-of-network...
, etc. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration issues such as Social Security... activities required to properly investigate claims such as Subrogation, Risk Control, nurse consultants, and fire or fraud...
The RN Float Case Manager and Utilization Review Nurse provides coverage for an RN Case Manager or RN Utilization... Review Nurse. The RN Float Case Manager and Utilization Review Nurse is assigned to function in the role of either a RN Case...
) or Master’s degree in Nursing Licensure/Certification: Required: California Registered Nurse (RN) licensure Preferred... Interqual guidelines, Knowledge of notices of non-coverage/denial letters to patients including Medicare/CMRI, federal and state...
with the charge nurse, social worker, physician and other members of the interdisciplinary team to facilitate safe and timely...: Required: California Registered Nurse (RN) licensure Preferred: Certification in Case Management Experience: Required: Two (2) years...
for denial avoidance strategies including concurrent payer communications to resolve status disputes. Qualifications...RN Utilization Management Nurse – Frontline Opportunity Greater Orlando, Florida The RN Utilization Management Nurse...
on relatively complex case types that require the training and skill of a registered nurse. Acts as a resource for more junior... pre-certification, concurrent, retrospective, out of network and/or appropriateness of treatment setting reviews...
, etc. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration issues such as Social Security... activities required to properly investigate claims such as Subrogation, Risk Control, nurse consultants, and fire or fraud...
of benefits, communication of information to insurance company, billing certifications, concurrent managed care denial appeals... and Certifications Required: NJ State Professional Registered Nurse License. AHA Basic Health Care Life Support HCP Certification...
’ acute care hospital experience required. Prior experience as an inpatient utilization review nurse or UM specialist..., and Denial Management preferred. Excellent interpersonal skills with the ability to manage sensitive and confidential...
reviews. The employee communicates with physician and case managers regarding payor approval/denial of admission and continues... conducts admission and concurrent reviews including observation and inpatients, identifies patients who do not meet criteria...
, retrospective and concurrent review and processing of authorization requests for inpatient admissions, outpatient procedures..., homecare services and durable medical equipment. Generates required correspondence, including denial letters, based on medical...
, co-insurance, coverage limits, etc. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes... such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators and to other experts. Requests through Unit Manager...
% a. Completes all job requirements related to prospective, concurrent and retrospective case review and reporting quality issues... efficiency of services provided and minimize consumption of resources. e. Triages concurrent denials for potential P2P...
, etc. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration issues such as Social Security... activities required to properly investigate claims such as Subrogation, Risk Control, nurse consultants, and fire or fraud...