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 Qualifications: ~3 years clinical experience in a geriatric, home care or primary care setting ~ Board Certified as a Nurse Practitioner or Physician Assistant ~ Unlimited Licensure in the state of Massachusetts ~ Active DEA License The salary range...
...MindSource is looking for a PROGRAM MANAGER, based in Sunnyvale, CA. Please see the job description below: The Program Manager... ...; resolution, color space, and other technical requirements of assets needed for image reproduction Good working knowledge of...
80Twenty is a boutique marketing recruitment agency that connects high-growth companies with exceptional candidates. Want to build technology that truly moves the needle in healthcare? Join a fast-scaling, profitable healthcare services company independently grown...
...Position: EMT-B Location: Port Arthur, TX Job Type: Travel Assignment Overview: Join a private EMS company providing 911 emergency services and inter-facility transfers (IFTs) in Port Arthur, TX. This is a 16-week assignment designed for experienced...
...Tutor Me Education is reshaping how students learn. We are looking for teachers and tutors with virtual tutoring experience to provide... ...Requirements Job requirements: Previous tutoring/teaching Spanish experience highly preferred Previous experience with...