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.
...About the Role We are seeking an experienced and motivated VP of Sales and Operations / General Manager to oversee sales and operational functions across residential, commercial, and volume-builder projects. This position plays a key role in guiding customers through...
...Safety conscience Current technology and trends Express ideas clearly, concisely, and effectively orally and in writing Exercise appropriate judgment in answering questions and releasing information; analyze and project consequences of decision and/or recommendations...
...MondayFriday, 8:00 AM5:00 PM Location: Fully onsite in Humble, TX Position Overview We are seeking an experienced Medical Billing Specialist to support a growing cardiology practice in Humble, TX . This fully onsite role is responsible for end-to-end...
...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...
...Southwestern region, offering comprehensive services in property management, acquisition, renovation, and rental. The company is... ...Description This is a full-time, on-site role for an AI/Social Media Specialist located in Albuquerque, NM. Responsibilities include...