, with an emphasis on Concurrent Review and Utilization Management High school diploma or GED required Bachelor's degree in Nursing...) or more years of Utilization Management/Case Management in a health care delivery setting in Acute or Skilled nursing...
management scope of services including: Utilization Management supporting medical necessity and denial prevention; Transition... patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient...
for case management scope of services including: Utilization Management supporting medical necessity and denial prevention... coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the...
: Required: California Registered Nurse (RN) licensure Preferred: Certification in Case Management Experience: Required: Two (2) years... recommendations when alternate levels of care are indicated. 17. Escalates to the Utilization Management Committee through the...
) Certification. 3. Registered Nurse (RN) License. 4. Three (3) years of Case Management experience. 5. Certifications... and continued stay, in order to reduce denial rate. 14. Documents care management activities in the initial assessment and as the...
transitions in levels of care. ACCOUNTABILITIES: Provide on-site and/or telephonic inpatient case management and concurrent... utilization management for HealthPartners members admitted to Out of Network Facilities, acute rehabilitation facilities...
transitions in levels of care. ACCOUNTABILITIES: Provide on-site and/or telephonic inpatient case management and concurrent... utilization management for HealthPartners members admitted to Out of Network Facilities, acute rehabilitation facilities...
transitions in levels of care. ACCOUNTABILITIES: Provide on-site and/or telephonic inpatient case management and concurrent... utilization management for HealthPartners members admitted to Out of Network Facilities, acute rehabilitation facilities...
inpatient admission review within 24 hours or first working day after admission and concurrent utilization review as necessary...: $53.00 - $82.08 Schedule: Full Time Shift Hours: 12 Hour employee Department: Case Management Social Services Job Objective: Responsible...
: Utilization Management supporting medical necessity and denial prevention Transition Management promoting appropriate length... health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self...
screening and clinical assessment for all proposed admissions. Coordinate bed utilization for all internal and external points... and functional status. Perform pre-certification with insurance company and communicate authorization/denial to internal referrals...
provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities... regarding admission status and acute care criteria, utilization management issues, care coordination and discharge planning...
patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria... in accordance with contractual agreements. Works collaboratively with physicians and managed care companies on concurrent denial...
: Utilization Management supporting medical necessity and denial prevention Transition Management promoting appropriate length... health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self...
for referral to appropriate provider. *Maintains awareness of financial reimbursement methodology, utilization management, payer... coordination and/or utilization management experience preferred. Basic Life Support (CPR) certification required. ACUTE...
to five years clinical experience as a Registered Nurse in a clinical setting required. 2 years’ experience as a Utilization... Management/Prior Authorization nurse in a managed care payer preferred. One year experience as a case manager in a payer...
provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities... regarding admission status and acute care criteria, utilization management issues, care coordination and discharge planning...
for utilization review on assigned unit. Facilitates third party reimbursement by responding to third party payer requests... for concurrent clinical information in support of ongoing services, turnaround time by day end. 7. Works closely with attending...