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Timely concurrent and retrospective appeals are a priority. Description Absolute Care offers concierge health services using a risk-bearing, PCP-driven care model. We treat the most clinically complex and vulnerable members of the communities we serve, many... Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connec...
Perform medical review activities pertaining to utilization review, quality... Performs utilization review services in compliance with federal and state regulations, and the URAC standards for client members seeking healthcare treatment and services. Obtain, analyze and document all supporting clinical within the documentation... Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations/guidelines. Analyzes clinical service requests from members or providers against evidence based clinical ... Assess inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state/federal regulations and guidelines.
Transport Licensed Practical Nurse
Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Support effective implementation of performance improvement initiatives. Facilitate communication between managed care/commercial payors and providers regarding benefit coverage issues, utilization review and quality assurance processes.
Utilize provider billing manuals to obtain billing guidelines and requirements. Special Handling billing included not limited to interim bills, overlap review, redistribution of money... Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual or MCG criteria. Participate in telephonic discussions with emergency department physicians relative to documentation and admission...
What is the job market like for utilization review nurses in Ridgefield Park, NJ?
Discuss and educate treating physicians regarding alternative courses of action or modification to the treatment plan, including but not limited to, appropriate documentation of the plan of care, to resolve utilization issues. We are in the business for more than 10 years and has placed thousands of healthcare and allied health professionals and counting, throughout the tristate area of New York, New Jersey, and Connecticut. Save time and find higher-quality jobs than on other sites, guaranteed. Utilize experience and understanding of flow through taxation, partnerships, and s-corporations. Provide tax compliance, planning and advisory services to clients. Review workpapers prepared by staff, recommend changes, and implement additional...
Review inpatient and outpatient denial data and assist in the development of denial prevention interventions. Review retrospective denials and third-party audit denials that are determined to require write-off by corporate CM. Take active role in analyzing corporate CM reports and identifying opportunities for improvement, utilization trends within each institution and system-wide, and propose potential solutions to executive management to address issues as appropriate.
URGENT HIRING! CNAs LPNs
Responsible for authorizations for outpatient services or ancillary services in preparation... Manage document review projects to include project staffing, security, facilities, and technology needs. Ensure that reviews are completed on time and within budget utilizing qualified internal or vendor staff that is available, trained, and productive.
Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex... Provide medical leadership for all utilization management, pharmacy, case management, disease management, cost containment, and medical quality improvement activities.
Advise, assist and educate treating physicians, hospital care managers, senior medical management, administration and all others involved in the delivery of timely, appropriate and cost-effective care. Full-time administrator who possesses the training and education necessary to meet the requirements for quality improvement/utilization review activities required in the Contract. Provide organizational leadership in the operational areas of care management, utilization review, appeals, quality improvement and related policy and practice initiatives in collaboration with the Corporate Medical Director, Utilization Management... Document clearly and concisely, following hospital guidelines, all communications, interactions, interventions and outcomes of medical director work in care management documentation system. Promote hospital adherence to ensure compliance with government and commercial payors policies regarding level of care and medical necessity. Conduct financial and healthcare utilization analysis and reporting to support Medicaid program compliance and evaluation.
Overseeing the quality of clinical care for network and non-network providers. The average utilization review nurse in Ridgefield Park, NJ earns between $58,000 and $105,000 annually. This compares to the national average utilization review nurse range of $47,000 to $89,000. At DRIFT, we work with healthcare companies across the United States to help recruit for frontline staff positions.
You'll be responsible for providing clinical review of cases using standard criteria to determine the medical appropriateness of inpatient and outpatient services while supporting our members through assessment, care and conservation. Analyze medical documentation to formulate a clear and concise clinically based argument to overturn denials. Exhibits clear and complete communication when documenting in company or client systems. Masters level degree in business and/or health care administration (i.e. MBA, MHA, MMM) preferred. Provide education on utilization management topics to the hospital medical staff.
If you re looking for a fulfilling career, then it s time to join the Rivers Edge Rehabilitation and Healthcare Center team as an LPN. If you re looking for a fulfilling career, then it s time to join the King David Center for Nursing & Rehabilitation team as an LPN. LPN- Licensed Practical Nurse for Pine Acres in Madison Working at Pine Acres truly means becoming a member of our family. As an Senior Medical Economics Analyst, you will be working cross-functionally providing consultative support and medical cost based analysis of markets and network initiatives.
We are currently looking for a Licensed Practical Nurse to join an amazing team at one of our skilled nursing facilities. The Attorney Analyst will support the Legal Spend Solutions team providing legal billing review services, utilizing their expertise, insights, and comfort with data analysis to help clients to drive cost savings and manage outside counsel spend... Develop and manage software engineering applications utilizing standard development tools. Provide technical consultation as well as expertise to Product Managers. Stimulate hiring, career plans, training as well as performance reviews...
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