- Houston Methodist (The Woodlands, TX)
- …case manager to facilitate discharge planning, seeks assistance from the physician advisor , if needed, and informs management of the possible need for ... position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient population on a designated unit(s). This position… more
- AdventHealth (Tampa, FL)
- …topics, DRGs and denials . Acts as a direct contact for the Physician Documentation Improvement designee ( physician advisor ) and site administration. ... as needed, to enhance staff development; leads hiring, training and performance management processes for all site-based CDI employees; coaches, mentors and empowers… more
- Catholic Health Services (Melville, NY)
- …Manage Care Payors or regulatory agencies, as needed or requested. + Manages physician advisor reports and assists with facilitating UM Committee reviews when ... hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the… more
- Tenet Healthcare (Detroit, MI)
- …the following activities: a) accurate medical necessity screening and submission for Physician Advisor review, b) care coordination, c) transition planning ... prevent avoidable readmissions. This position integrates national standards for case management scope of services including: Utilization Management supporting… more
- Whidbey General Hospital (Coupeville, WA)
- …status / level of care) concerns and other utilization mangement concerns to Physician Advisor or designated leader, as appropriate. Assists with discharge ... regime, etc. The RN - Care Manager follows the hospital's Case Management /Utilization Plan that integrates the functions of utilization review, discharge planning,… more
- Rochester Regional Health (Rochester, NY)
- …patients across the continuum. + Appropriately identifies and refers cases to the Review Physician Advisor to validate level of care based on medical necessity ... Job Title: Care Facilitator Department: Case Management Location: Canton-Potsdam Hospital with floating to other...plan of care. + Performs retrospective reviews on insurance denials and assists in appeal process. + Participates in… more
- Catholic Health Services (Roslyn, NY)
- …skills to ensure timely resolution of issues. + Refers cases and issues to Physician Advisor in compliance with identified procedures and follow-up as indicated. ... Overview Director-Care Management Are you exceedingly driven, dedicated, and passionate...denials . + Serves as a resource to physicians, physician advisors, CM department, and hospital staff. + Collaborates… more
- Nuvance Health (Poughkeepsie, NY)
- …and at a minimum the case manager reviews observation cases daily. 3. Utilizes physician advisor to interface with physicians as needed. 4. Collaborates with the ... to prevent the denial where possible. 5. Supports the effective prevention and management of denials , including providing information as part of the appeal… more
- Trinity Health (Nampa, ID)
- …and requested by third party payers and Medicaid. + Responsible for appeals, denials , as appropriate. Utilizes physician advisor referral as appropriate. ... supplies provided to the patients. + Completes a screening/assessment of physician assigned cases to determine medical necessity/status determinations and transition… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …avoidable days, trends, and actions to UR Committees, as appropriate * Partners with Physician Advisor to engage in second level review and working with ... functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, financial, and… more