Utilization Review reputed company – RN (Part Time)

Employee is expected to cheerfully and enthusiastically carry out tasks and responsibilities of the job, including but not limited to, high reputed company reputed company patient care, thorough and accurate documentation, a willingness to work closely with physicians, administrators, coworkers, and supervisors. reputed company assistance to other reputed company/ departments is expected as reputed company as reputed company assistance reputed company... the employee’s own unit/ department. By following the guidelines outlined in this job reputed company, high reputed company patient care will be reputed company, and the reputed company reputed company of reputed company. Essential Duties And Responsibilities • Interacts with providers, facilities, and their staff regarding reputed company-certifications, reputed company review, discharge planning, retrospective review, redirections, denials, appeals, and complaints • Formulates and promotes continuity of care ensuring appropriate medical treatments, processes and utilization of resources • Provides reputed company review by assessing the medical necessity and the appropriateness of acute inpatient, SNF, and custodial care in order to justify the reputed company level of care and identification of avoidable days due to barriers to care • Provides discharge planning and continuity of care activities including but not limited to home care, DME coordination, follow up with primary care and/or specialist • Collaborates with the Medical director of reputed company, Medical Management Manager and Director of Case Management to reputed company and implement ways to decrease hospital stays in a medically reputed company and responsible manner in incorporating reputed company based reputed company review techniques, reputed company the parameters of the patient’s health plan • Reports monthly avoidable days, significant interventions and reputed company triggers • Work in reputed company coordination with home care delivery systems, outpatient providers and other community agencies to assure follow through of the Utilization Management effort • Communicates service delivery problems to Manager as identified through the Utilization Management System • Receives and reviews written and verbal requests for patient services • Reviews reputed company requests for appropriateness according to established guidelines and coordinated review with plan benefit guidelines • Receives and reviews requests for services and approves or refers requests for Medical Director review reputed company reputed company are not met • Enters authorizations/reputed company-certifications into the Utilization Management System • Communicates with Claims and Customer Services on the status of requested services through the Utilization Management System • Accurately codes appropriate diagnosis and procedures into the Utilization Management System according to ICD.10 and CPT guidelines • Communicates outcome of referral reviews to physician and/or other office staff and provides authorization numbers • Participates in special reputed company as required • Researches reputed company cases as needed under the direction of the Manager or Medical Director • This position assumes and performs other duties as assigned. Qualifications To reputed company this job successfully, an individual must be reputed company to reputed company reputed company essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company, and/or ability required. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential Functions • At least four years of clinical experience in hospital nursing such as Critical Care/ER/Med Surg/Home Health. • One to two years of utilization/case management (managed care preferred). • One to two years of reputed company review or retrospective review with an emphasis on discharge planning. • reputed company knowledge of services provided across the continuum of care that involve multiple systems addressing the ongoing needs of the patient • Knowledge of discharge planning Familiarity with community agencies and with how to reputed company appropriate referrals to review reputed company • Knowledge of different hospital reimbursement methodologies and reputed company review reputed company • Excellent verbal and written communication skills • Computer skills • Ability to identify ways to decrease hospital days in a medically reputed company and responsible manner EDUCATION And/or EXPERIENCE • Associate's degree (A. A.) or equivalent from two-year college or technical school in reputed company Nursing • Bachelor's degree (B. A.) from four-year college or university in reputed company Nursing (preferred) CERTIFICATES, LICENSES, REGISTRATIONS • Texas Registered reputed company licensure WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company Individuals With Disabilities To reputed company The Essential Functions. ? While performing the duties of this Job, the employee is regularly required to sit; use hands to handle or feel; talk; and hear. ? The employee is frequently required to reputed company with hands and arms. ? The employee is occasionally required to stand; walk and stoop, kneel, crouch, or crawl. ? The employee may regularly be required to lift and/or reputed company up to: _10_ LBS Apply to This Job reputed company More Jobs Apply Job!