RN UTILIZATION REVIEW DE jobs in GEORGIA, United Kingdom

, federal and state hospital Utilization Review (UR) regulations and Medicare guidelines regarding medical necessity, inpatient... medical records or acute hospital utilization review using InterQual or Milliman. Working knowledge of medical coding, case...

, federal and state hospital Utilization Review (UR) regulations and Medicare guidelines regarding medical necessity, inpatient... hospital utilization review using InterQual or Milliman. MINIMUM LICENSURE / CERTIFICATION REQUIRED BY LAW: Current License...

ADDITIONAL QUALIFICATIONS: Master's degree preferred and three years utilization review or Care Management experience... services to include covered days and associated services. This position requires Pediatric/NICU Utilization Management...

review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review Specialist... utilization review Education Graduation from an accredited school of nursing Certification Summary Licensure...

abuse utilization review process preferred. Experience working with providers and healthcare teams to review care services... to determine medical appropriateness in accordance with regulatory guidelines and criteria Performs concurrent review...

utilization review or Care Management experience... registered nurse (RN) license, in the state of Georgia ADDITIONAL QUALIFICATIONS: Master's degree preferred and three years...

. How do I know this opportunity is right for me? If you: Are familiar with MCG criteria and Utilization Management Platforms (e.g... (electronic medical record systems, utilization management systems, claims systems, etc.). Keep current with medical knowledge...

completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees... Experience in pediatrics 2 years of experience in hospital or insurance related utilization review; extensive case management...

/ Mental Health Care Advocate you will be responsible for utilization review of behavioral health and substance abuse cases... Psychology, Social Work, Counseling, or related behavioral health discipline, OR an RN with 2+ years of experience in behavioral...

the electronic medical record through education, review, and data analysis. Communicate with Utilization Manager... training processes created for new providers in electronic medical record documentation. Review importance of timely...

and training to support the hospital’s mission of driving high-quality utilization of healthcare resources. The Care Coordination.... Qualifications Graduate of an accredited Registered Nursing School (RN) with a current GA RN license or MSW/BS degree in related...

Annual Standing Order Review and ICD coding. Checks correspondence whether electronic, paper or voice mail, and responds... utilization of medication, laboratory, inventory, supplies and equipment to achieve supply cost goals following all guidelines...

Annual Standing Order Review and ICD coding. Checks correspondence whether electronic, paper or voice mail, and responds... utilization of medication, laboratory, inventory, supplies and equipment to achieve supply cost goals following all guidelines...

services Participates in and facilitates patient/family education and communication Utilization Review Identifies need... documentation of non-commercial utilization review function per hospital policy and federal and state requirements Utilizing...

: Responsible for maintaining and updating all FMS manuals. Accountable for completion of the Annual Standing Order Review and ICD... gathering as required supporting billing and collection activities. Responsible for efficient utilization of medication...

beneficial effect; refers cases to Utilization Review as indicated. Demonstrates a working knowledge of the DRG system... on an ongoing basis. Minimum Job Qualifications Licensure or other certifications: Current RN Licensure in the State of Georgia...

Annual Standing Order Review and ICD coding. Checks correspondence whether electronic, paper or voice mail, and responds... utilization of medication, laboratory, inventory, supplies and equipment to achieve supply cost goals following all guidelines...