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.
...Aspen Dental Management, Inc. (ADMI) is one of the largest and most trusted retail healthcare business support organizations in the U.S., supporting 15,000 healthcare professionals and team members at more than 1,000 health and wellness offices across 46 states. ADMI...
...fostering a supportive environment for our team members. Role Description This is a full-time on-site role for a CDL Class A Driver/Skid Steer Operator, located in Cicero, IL. The responsibilities include operating and maintaining skid steer equipment,...
Responsibilities Achieve warehouse performance objectives, in particular by establishing warehouse on-the-floor operation excellence daily management methods; define cost saving, productivity and service level improvement opportunities, measure performance, analyze ...
...Job Description Skid Loader Operator Final grading on commercial and residential projects. Prep sub-grade for topsoil placement. Prep topsoil for landscape companies. Landscaping experience a plus. We have the newest equipment in...
...Scheduler Overview The Scheduler works closely with the Project Team to uphold Project Controls standards and ensure accurate management of quantities, costs, and schedules from estimating through completion. This hands-on role collaborates directly with estimating, design...