Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). Contributes to moderately complex aspects of a project. Work is generally independent and collab ...orative in nature. Typically requires 4 to 7 years of related experience.More Show Less
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JOB DESCRIPTION. Job Summary. The primary goal is to monitor adherence to the facilitys utilization review plan to ensure the effective and efficient use of facility services and monitor the appropriateness of facility admissions and extended facility stays. Job Classification. Non Exempt Hourly. Reports To. . Senior RCM Director. Supervisory Responsibilities. None. JOB DUTIES. Completes Initial, concurrent, peer reviews, and expedited appeals in...
Description of Work. This is an anticipated vacancy. The primary purpose of this position at Caswell Developmental Center is to facilitate the review of resident records against established criteria for maintaining intermediate care facility (ICF) and Medicaid standards/eligibility for all residents. It involves consulting with the attending physician when documentation does not reflect established criteria for services. This position is responsi...
Description of Work. This is an anticipated vacancy. The primary purpose of this position at Caswell Developmental Center is to facilitate the review of resident records against established criteria for maintaining intermediate care facility (ICF) and Medicaid standards/eligibility for all residents. It involves consulting with the attending physician when documentation does not reflect established criteria for services. This position is responsi...
Utilization Review Coordinator needed for our Patient Financial Services department. . Eligible for Employee Referral Bonuses…refer a friend and earn $$$. General Objectives. Coordinates with Valley View departments, patients and payers regarding ordered procedures to verify orders meet medical necessity guidelines. Assists patients and families with access to healthcare by obtaining Authorizations. Qualifications. Education. Medical Assistant. M...
A company is looking for a UR Index Intake Coordinator to manage electronic medical case files and perform intake processing for Utilization Review referrals.Key ResponsibilitiesScan, index, categorize, and upload medical records to corresponding case filesProcess Utilization Review referrals and assist with administrative overflow tasksInteract professionally with healthcare professionals and handle incoming callsRequired QualificationsHigh Scho...
