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.
...Akkodis is seeking a Sr. Scrum Master for a contract position with our Fortune 500 banking client. Rate: $75-$88/hr W2. The rate may be negotiable based on experience, education, geographic location, and other factors. Location: Plano, TX Overview: This...
...AI tools like Claude Code, but if thats the only way you can get things done, were probably not a good match Nice to Haves ~ CRO or growth engineering background ~ Experience with A/B testing frameworks ~ Startup or high-growth product experience ~+2 for...
...socialization, homework help, academic enrichment, conflict resolution, recreation, community circle, and clubs. Position: Mentor Teacher Reports To: Supervisor II Location: 4105 Farragut Road, Brooklyn NY 11203 What The Mentor Teacher Does: The person...
...owned and operated manufacturing business located in Fond du Lac, is looking for a motivated professional to join our team as a CNC Programmer! RB Royal is a premium manufacturer of fluid transfer systems. Think custom coils, tubing and hoses that move water, air, oil...
...We're hiring a Customer Service Representative on a part-time basis for a growing client in Milford. This role is ideal for someone who... ...primary point of contact for customers via phone, email, and online portals Accurately enter and manage orders in the ERP system...