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.
Please send current resumes directly to ****@*****.*** Bhagyashree Yewle, Principal Lead Recruiter- YOH SPG FULL TIME Lead Platform Engineer with Python Programming & AWS Cloud - HYBRID ONSITE Location Flexibility: This role is based 4 days per week...
Step into a pivotal Sterile Processing Tech role in Scottsbluff, Nebraska, where your expertise in decontamination, sterilization, and instrument... ...the United States, giving you the chance to broaden your experience, encounter diverse equipment and protocols, and strengthen...
New Tech Staffing is seeking a JDE Developer Analyst for a manufacturing company in Houston (77055). This is a direct hire opportunity offering a base salary of $120,000-125,000. Overview Seeking a seasoned Developer Analyst with deep expertise in Oracle Visual Builder...
...expectations; and lifting the experience by creating innovative ways to ensure the customer has the best shopping experience possible. Assists customers with an Alton Lane one-on-one appointment based experience Implements and models customer service standards by...
...Skill: Quality Assurance Analyst Must Have Technical/Functional Skills: Quality Assurance Analyst. Banking Domain knowledge. Teller Testing experience (preferrable). Minimum 5-6 years of testing experience. Primarily manual testing. Create and...