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.
A medical group in Wilmington, North Carolina, is conducting interviews for Family Medicine physicians. The ideal candidate will be able to establish a busy practice quickly. Opportunity See 20-25 patients per day Work in a small group setting Looking for...
...presentations.+ 40% - Support Development - Assist, train, and support development of part-time administration assistants. Support general office management, answer, and direct incoming calls, maintain and process incoming emails expeditiously, oversee branch voice mail,...
(Physician/MD qualifications required) Internal Medicine - We are seeking a BE|BC Primary Care Provider (IM or FM) to join a multi-specialty group in southeastern Massachusetts. Overview: Must be Board-Eligible|Board-Certified to be considered Active MA license...
Job Overview: Responsible for entering patient data into the State of NJ Birth Registration database with a high level of accuracy. Maintain communication with consortium and state departments providing statistics. Qualifications: Required: ~ High School Diploma...
Senior Web Designer Needed in ShanghaiWe are a fast-growing E-commerce company - subsidiary of Essilor International and our main market... ...also welcomeJD for Senior DesignerResponsibility:1. Define website layout, create unique displays and digital design solutions.2....