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.
...of jurisdiction (required prior to start date) Eligibility to participate in Medicare Board certification or eligibility in an ABMS or AOA-recognized specialty (preferred) FMCSA NRCME certification (preferred or willingness to obtain) Benefits ~ Work-Life...
...Title: Targeted Marketing Specialist Pay Rate: 20-23/hr Location: Irving - onsite Monday-Thursday - (WFH Friday) Contract length: 3 month contract to hire Reporting to the Manager Targeted Marketing, the Targeted Marketing Specialist is responsible for the...
...Position Summary: The Personal Assistant to the Chief Executive Officer provides various personal and professional duties. Essential... ... experience in assisting high profile individuals Valid drivers license required Experience in managing various levels of...
...Job Title: Scrum Master Data Governance Location: San Antonio TX Job Description: We are looking for a skilled Scrum Master with strong experience in Data Governance to support and drive Agile delivery across data-focused programs. The Scrum Master will facilitate...
School Social Worker- Onsite: Lansing, MI Ready to change lives at every grade level? Seeking a dynamic School Social Worker who thrives on adaptability and impact. Support students as they grow socially, emotionally, and academicallyhelping them overcome challenges ...