To provide quality case management services to all patient populations and their families. To serve as a member of the interdisciplinary team supporting the organization’s treatment program and philosophy and assure the deliverance of quality treatment to patients and their families. To proactively monitor and optimize reimbursement for organization services.
• Maintain appropriate records of the Utilization Review Department.
• Prepare and submit appeals.
• Attends mandatory training.
• Conducts admission reviews and pre-certs.
• Conducts concurrent and extended stay reviews.
• Prepares and submits appeals to third party payors.
• Schedules and conducts treatment team meetings to provide total case management of the patient by reading and discussing written progress notes from charts and communicating any state or local agency legal requirement for case management with the interdisciplinary team.
• Participates in activities which enhance professional growth and development.
• Demonstrates conduct in keeping with CCBH’s ethical standards.
• Complies with facility safety, infection control and security program.
• Supports facility service excellence standards.
Graduate of accredited RN program with current RN license, or a Masters in Counseling/Social Work or related field. Experience in psychiatric nursing preferred; high school, preferably college level reading, writing, and math skills. Excellent telephone, computer, and communication skills. Knowledge of health care service delivery systems and third party reimbursement; understanding of admission and discharge function. Familiar with medical terminology, diagnostic terms and treatment modalities; knowledge of medical record keeping; strong interpersonal, organizational, evaluative, and time management skills; policy interpretation skills. Must be familiar with applicable standards and regulations. Flexible; pays attention to detail; able to comprehend psychiatric evaluations, consults, labs, etc.; responsiveness to deadlines; assertiveness, persistence and persuasiveness; able to work with minimal direction or supervision.
...development programs to support recruitment and retention. VHS is owned and operated by a subsidiary of Universal Health Services, Inc. (UHS). Each employee at VHS takes part in the UHS Service Excellence Program. The program is guided by three standards: "Treat everyone as...
...may be occasional situations that require work to be performed on-site at an assigned Lee Health location. The Epic Grand Central Senior Application Analyst responsibilities may include but are not limited to: -Part time position, 3 days one week and 2 days the...
...to switch between tasks and topics quickly and sometimes work with challenging, complex guidelines. Our freelance role is fully remote so, you just need a laptop, internet connection, time available and enthusiasm to take on a challenge. Benefits Why this freelance...
Dynamics 365 Software Engineer needs 5+ years of experience in Dynamics CRM (Sales, Marketing, Services, Case Management) Dynamics 365 Software Engineer requires: -Onsite -Dynamics 365 hands-on knowledge, building complex Customizations and integrations -Experience...
...causality. Perform all appropriate coding using MedDRA, WHO-DRUG, and Company Product dictionaries. Own case narrative - create... ...pharmaceutical/biopharmaceutical company. Minimum 3 years in Drug Safety Operations role. Experience overseeing CRO teams of case...