BSN ADMISSION AND DENIALS jobs in UNITED STATES, United Kingdom

for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently... criteria sets for admission reviews, continued-to-stay reviews, outlier reviews, and clinical appropriateness recommendations...

for admission and concurrent reviews assuring the prevention of denials from all payers. Assist with notification, submitting... admission to ensure appropriate discharge plan are implemented. Reassess and reevaluate the appropriateness for the plan...

reviews, admission denials, continued stay reviews, continued stay denials, termination of benefits, communication... at Hackensack Meridian Health includes: Follows departmental workflows for utilization review activities including admission...

includes: Follows departmental workflows for utilization review activities including admission reviews, admission denials..., continued stay reviews, continued stay denials, termination of benefits, communication of information to insurance company...

activities. Performs admission and concurrent utilization management using Hospital approved criteria as a guide... payers, delivers notices of Non-coverage and/or proposed insurance denials to patients/families according to payer, Hospital...

activities. Performs admission and concurrent utilization management using Hospital approved criteria as a guide... payers, delivers notices of Non-coverage and/or proposed insurance denials to patients/families according to payer, Hospital...

approval/denial of admission and continues stay review. Process payor denials and retro reviews. Promotes optimal health care... Management process not limited to and including: making clinical recommendations regarding medical necessity for admission...

, implementing and evaluating strategies to correct/improve problems/inefficiencies. Performs and/or delegates admission... and continued stay review for all payers and levels of care; performs these responsibilities within 24 hours of admission...

with payers to prevent inpatient denials. Performs retroactive reviews on discharged patients as assigned. Communicates any... necessary information to payers to help appeal existing denials. Uses level of care criteria to justify the patient's severity...

AND EXPERIENCE: Graduate from a BRN approved school of registered nursing; BSN preferred EDUCATION AND EXPERIENCE: Minimum of three... admission on the identified targeted patient population for appropriateness of hospitalization. Monitors appropriate...

, admission denials, continued stay reviews, continued stay denials, termination of benefits, communication of information... Meridian Health includes: Follows departmental workflows for utilization review activities including admission reviews...

of the interdisciplinary team. RESPONSIBILITIES Essential Functions Supervises Case Managers to ensure admission... review organizations and maintains communication as required to obtain certification for the admission. Establishes...

for an assigned group of patients to determine the appropriateness of the admission and continued stay, assist in the development... or continued inpatient stay Coordinating expedited appeals for inpatient denials with attending physicians and insurance providers...

for admission and concurrent reviews assuring the prevention of denials from all payers. Assist with notification, submitting... admission to ensure appropriate discharge plan are implemented. Reassess and reevaluate the appropriateness for the plan...

companies, utilizing insurance portals to submit and process approvals and denials. Purpose: The Care Manager (CM... with concurrent denial. Starts discharge planning on admission and ensures DC documentation is completed and updated regularly...

and responds to denials in a timely manner. Initiates the discharge planning assessment on admission. Coordinates discharge... for all patients in the caseload within 48 hours from admission and subsequent reviews within 24 hours. Provides utilization review in...

functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry... of care, and expected discharge plan Ensure that admission review is completed on assigned units/worklist using payer MCG...