- LA Care Health Plan (Los Angeles, CA)
- …and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The ... include inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to assist… more
- Mount Sinai Health System (New York, NY)
- …the clients responses to the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion but not less than every ... and other health team members. 6. Participates in peer review . 7. Incorporates research findings in clinical practice. 8....Ability to interpret and apply principles of nursing research utilization . 5. Ability to manage and coordinate a patient… more
- Mount Sinai Health System (New York, NY)
- …interprets the clients responses to the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion but not less than every ... and other health team members. + Participates in peer review . + Incorporates research findings in clinical practice. +...Ability to interpret and apply principles of nursing research utilization . + Ability to manage and coordinate a patient… more
- Veterans Affairs, Veterans Health Administration (Fayetteville, NC)
- …severity of illness, risk of mortality, complexity of care, and utilization of resources. Identifies opportunities for documentation improvement by ensuring that ... and completeness of clinical documentation. Inpatient CDI focuses on the concurrent review of patient records with an emphasis on improving documentation while the… more
- Royal Vopak (Deer Park, TX)
- …is a big plus + Good knowledge and experience of cost estimating software utilization + Good knowledge and experience of CAD software utilization + Expert ... project owner identifying project technical staffing requirements to support projects + Review and validate Project Management plans + Initiate and organize key… more
- Highmark Health (Little Rock, AR)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Sevita (Detroit, MI)
- …documentation; maintain confidentiality and adherence to individual rights standards; review and respond accordingly to adverse action regulatory correspondence and ... protocol; manage timely incident reporting and response to higher-level incidents; review trends; work with state operations and quality improvement leadership to… more
- Houston Methodist (The Woodlands, TX)
- …and federal programs + Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement ... patient satisfaction and safety measures. **FINANCE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use,… more
- Stantec (Long Beach, CA)
- …range of market sectors that leads to an expected 60% direct utilization - Primary point-of-contact for planning-related pursuits, inputs to operational and business ... selling of services - Track and manage the planning group's overall utilization in collaboration with supervisors including identifying key leads and support staff… more
- Aveanna Healthcare (Phoenix, AZ)
- …is responsible for owning relationships within all of case management and utilization management departments. This individual will work with AVPs of Payor Relations, ... Job Functions Develop and own relationships with all case management and utilization management departments within assigned payor accounts. Hold weekly or monthly… more