5 utilization review rn jobs found

DESCRIPTION OF POSITION: The Psychiatric Case Manager supervises day to day functions of the department and staff. The manager actively seeks areas for department to improve (i.e - reduction in denials) &/ or be more efficient. SUPERVISION: Reports directly to the Practice Director RESPONSIBILITIES AND DUTIES: Prepares information for notification letters for providers and employees. Performs utilization review in accordance with all state mandated regulations. Maintains compliance with regulation changes affecting utilization management. Performs continuing review on medical records and identification and need of on-going hospitalization. Reviews patients' records and evaluates patient progress. Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct review. Reviews and validates physician's orders, reports progress and unusual occurrences on patients. Receives & processes requests for appeal of...

DESCRIPTION OF POSITION: The Director of Clinical Case Management develops, implements and enforces policies and procedures which support the Hospital's mission, goals and objectives. SUPERVISION: Reports directly to VP of Financial Services RESPONSIBILITIES AND DUTIES: Ensures that staff complies with mandatory education, licensure requirements, mandatory health requirements, etc. Develops annual departmental budget and operates within budgetary guidelines. Recommends and ensures appropriate staffing levels. Allocates resources according to priorities. Identifies and resolves problems in a timely manner. Gathers and analyzes information skillfully. Develops alternative solutions. Generates creative solutions and attention to detail. Seeks increased responsibilities. Looks for and takes advantage of opportunities. Demonstrates persistence and follow through even when faced with adversity or challenges. Balances team and individual...

DESCRIPTION OF POSITION: The Coordinator of Clinical Outcomes assists in the ongoing evaluation of the organization's Performance Improvement Program. Participate in corrective action discussions and performance improvement initiatives as assigned. Maintains knowledge of organizational compliance requirements and regulatory standards. Supervision: Reports directly to the Director of Quality Management RESPONSIBILITIES AND DUTIES: Coordinates data collection, analysis, and submission activities necessary for regulatory compliance and quality reporting programs. Supports the medical staff quality improvement and peer review process. Oversee/supervise Core Measure Reporting Supervise Core Measure Abstracters Assists with quality and performance improvement efforts throughout the organization and supports the operation of quality management systems. Demonstrates the ability to appropriately plan and prioritize work, facilitate collaboration, and support...

DESCRIPTION OF POSITION: The Psychiatric Case Manager supervises day to day functions of the department and staff. The manager actively seeks areas for department to improve (i.e - reduction in denials) &/ or be more efficient. SUPERVISION: Reports directly to Director of Psychiatric Services RESPONSIBILITIES AND DUTIES: Prepares information for notification letters for providers and employees. Performs utilization review in accordance with all state mandated regulations. Maintains compliance with regulation changes affecting utilization management. Performs continuing review on medical records and identification and need of on-going hospitalization. Reviews patients' records and evaluates patient progress. Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct review. Reviews and validates physician's orders, reports progress and unusual occurrences on patients. Receives & processes requests for...

DESCRIPTION OF POSITION: The Psychiatric Case Manager supervises day to day functions of the department and staff. The manager actively seeks areas for department to improve (i.e - reduction in denials) &/ or be more efficient. SUPERVISION: Reports directly to Director of Psychiatric Services RESPONSIBILITIES AND DUTIES: Prepares information for notification letters for providers and employees. Performs utilization review in accordance with all state mandated regulations. Maintains compliance with regulation changes affecting utilization management. Performs continuing review on medical records and identification and need of on-going hospitalization. Reviews patients' records and evaluates patient progress. Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct review. Reviews and validates physician's orders, reports progress and unusual occurrences on patients. Receives & processes requests for...