Summary:
The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment. Interfaces with 3rd party payers by providing pertinent, relevant clinical information. Responsibilities Include: Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption. Enters clinical reviews into the software program. Maintains close communication with external reviewers/internal financial counselors/patient access personnel and performs certification activities as required by payor. Monitors and identifies patterns or trends in utilization management. Monitors potential and actual denials and coordinates with nurse Care Manager and/or Social Worker for any follow up necessary. Documents in software program the actions taken to coordinate care and avoid denials. Assists nurse Care Managers in communicating with the patient denied hospital days as well as the issuance of Medicare forms including HINN, Detailed Notice of Discharge to patients/family/significant other when they are in disagreement with the discharge plan arranged by attending and Care Management personnel. Coordinates with the Care Manager to achieve optimal and efficient patient outcomes, while decreasing length of stay and avoid delays and denied days. Utilizes Physician Advisor and administrative personnel for unresolved issues. Identifies opportunities for expedited appeals and collaborates with the Care Manager and Physician Advisor to resolve payer issues. Other tasks as assigned. Sends appropriate referrals/escalations to the physician advisors to review cases not met with criteria REQUIREMENTS: Registered Nurse License - Current Maryland license or eligibility to obtain Maryland license Associate's Degree in Nursing required; BSN or higher preferred Minimum of 3 years of related experience Pay Range: $40.12 to $62.19 Based On Experience Benefits:...Technical Product Owner (Glenview, IL)*Please consider before applying: While this is a remote role, the selected candidate must physically reside in Glenview, IL or nearby surrounding area. Position Overview: The primary responsibility of the Technical Product...
...operations, spot trends on TikTok/Reels, and produce high-quality content that drives appointments.What you will do:Content Production:... ...make content look "expensive" even on an iPhone.Independent Creator: You can take a loose concept and run with it. You don't need...
...An established industry player is seeking a Senior Project Manager to lead their Wind Energy practice in Apple Valley, Minnesota. This role involves managing a dedicated team, fostering client relationships, and overseeing all aspects of wind energy projects from design...
...Description Seeking upbeat, skilled and responsible individuals to join our amazing laid back team. We are a new, trendy, vibrant nail spa in Brooklyn that caters to the customer and employees. Showcase your craft and talent in a fun atmosphere, while earning competitive...
...CompassionMD provides affordable, direct virtual medical care to individuals, families,... ...medical guidance, and other valuable health services at predictable, transparent pricing.... ...existing network Track enrollments and customer follow-up Collaborate with internal...