1 senior clinical specialist jobs found

Job Summary :  Completes initial review for medical necessity for all admissions in assigned area(s), applying established criteria within 24 hours of admission. Assesses patient status, whether outpatient, observation, or inpatient and determines appropriateness of status and level of care based on criteria (Ex: Interqual). Communicates with physicians to ensure status and medical necessity are accurately determined. Refers to physician advisor and /or second level reviewer when necessary. Documents initial review, communications, and referrals in permanent medical record. For all observation patients in assigned areas, daily reviews of medical necessity will be performed and documented in medical review, including daily status update while patient is in observation status. Ongoing continued stay reviews are done for assigned areas. Concurrent reviews are to be documented in patient medical record and shared with managed care organizations when requested. Assesses for best...