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.
...Required Skills & Experience ~4+ years of project management experience ~ Lean Six Sigma belt or working in Lean Six Sigma principles ~ Strong and proactive communication with stakeholders and executive leadership ~ Jira and MS Project experience Nice to...
...Job Summary GHR Healthcare is seeking a dedicated and skilled Radiation Therapist for premier health system in Philadelphia, PA 19128! Local Rate: $59-62/hr Travel: $2610 gross per week Schedule: M-F 8 hour day shift. (FLEX between 6am-5pm) Job Description...
...Job Title: Warehouse Production Staff Location: North Brunswick Company: Blue Star Glass Job Type: Full-Time Shifts Available: 2nd shift (3:30pm to midnight) Reports To: Warehouse Supervisor / Production Manager About Blue Star Glass: Blue Star...
...Columbia Healthcare of Cascadia is Cascadia Healthcares Western WA and OR team of facilities. One of our facilities , Highland Health... ...a compassionate, mission-driven Chief Executive Officer / Administrator to lead our skilled nursing facility. In this role, youll oversee...
...Dermatology PA or NP Supportive, Collaborative Practice (Burbank, California) Skin and Beauty Center (SBC) is a well-established... ...are looking for a part or full-time, experienced dermatology Physician Assistant (PA) or Nurse Practitioner (NP) to join our highly...