need for care coordination, clinical utilization management and the transition to the next appropriate level of care..., but not limited to: Accurate medical necessity screening and submission for Physician Advisor review Care coordination...
need for care coordination, clinical utilization management and the transition to the next appropriate level of care... coordination, utilization management, or acute clinical care. Responsibilities: Essential Functions Initially and concurrently...
need for care coordination, clinical utilization management and the transition to the next appropriate level of care..., but not limited to: Accurate medical necessity screening and submission for Physician Advisor review Care coordination...
Partners with physicians and the Physician Advisor(s) to build and maintain effective relationships with physicians, services... experience in an acute hospital environment. Current license or valid permit to practice professional nursing in Texas...
’ risk factors and the need for care coordination, clinical utilization management and the transition to the next appropriate... population to include, but not limited to: Accurate medical necessity screening and submission for Physician Advisor review...
, and support teams through transition. Serve as a trusted advisor to project teams on change management best practices... and Readiness Plans Resistance Management and Sustainment Plans Saturation Assessments Define and track adoption, utilization...
and understanding in response to patient and customer requests/needs · Partners with physicians and the Physician Advisor(s) to build... hospital environment. Current license or valid permit to practice professional nursing in Texas. Certification in Care...
: Utilization Management services supporting medical necessity and denial prevention Coordinating with payors to authorize... for services from payors Performing accurate medical necessity screening and timely submission for Physician Advisor reviews...
, 3008, 1823 PASSR, and DCF mandatory legal reporting, etc. Works with the Utilization Department, Physician Advisors... plan goals. Works collaboratively and maintains active communication with physicians, nursing, physician advisor...
of stay and optimizing resource utilization; support utilization review: Collaborate with physicians and the physician advisor... is required. Active NJ RN license or compact RN license with NJ endorsement Certification in Case Management strongly preferred...
certification and prior authorization as appropriate. Refers cases when appropriate to physician advisor for medical necessity..., and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization...
and understanding in response to patient and customer requests/needs · Partners with physicians and the Physician Advisor(s) to build... hospital environment. Current license or valid permit to practice professional nursing in Texas. Certification in Care...
with physicians and the Physician Advisor(s) to build and maintain effective relationships with physicians, services, specialties... hospital environment. Current license or valid permit to practice professional nursing in Texas. Certification in Care...
hospital's Care Management program, including Utilization Review (UR), care coordination, discharge planning, and payer medical... physician advisor involvement when indicated. Care Coordination & Discharge Planning Oversees care coordination...
between the case management department and the physician advisor on a regular basis regarding utilization review and/or quality... Management policies Obtaining valid physician order prior to bed placement InterQual reviews Observation hours Excess Days...
where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal... to reduce readmission rate. h. Appropriately identifies and refers cases to the physician advisor to support timely...
utilization management, care facilitation and discharge planning functions. Knowledge, Skills and Experience: Education... by their leader. Leadership has the right to alter or modify the duties of the position. Utilization Management: Applies approved...
development and implementation of clinical protocols, quality improvement, utilization management, and regulatory compliance... and outcomes. Oversee utilization management activities, review and approve medical necessity for treatments, and facilitate...
. We are searching for providers throughout the state of Washington. Requirements: As Physician Reviewer/Advisor, you will utilize... practice with medical necessity and utilization review/management expertise Expanded credentials as an expert in Independent...
with the requirement that the physician advisor shall not have a financial conflict of interest -Must present evidence...Overview: Are you an accomplished Board Certified Physical Medicine & Rehabilitation physician? Are you passionate...