Utilization Review Nurse RN
1 week ago
ClickJobs is seeking a highly skilled Utilization Review Nurse RN to join our team. As a Utilization Review Nurse RN, you will play a critical role in ensuring the quality and efficiency of our healthcare services.
Key Responsibilities- Medical Record Review: Coordinate and review all medical records, as assigned to caseload, to ensure compliance with regulatory guidelines.
- Case Management: Actively participate in Case Management and Treatment Team meetings to ensure seamless coordination of care.
- Education and Training: Serve as an ongoing educator to all departments, providing training and guidance on healthcare best practices.
- Utilization Review: Responsible for reviewing patient charts to assess whether the criteria for admission and continuation of treatment is being met, gathering data, and responding to requests for records from fiscal intermediaries.
- Communication and Collaboration: Work closely with clinical staff, fiscal intermediaries, patients, and families to coordinate discharge referrals and provide timely and accurate referral determinations.
- Compliance and Quality: Ensure compliance with Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, and lower levels of care for the continuity of treatment.
- Reporting and Analytics: Gather clinical and fiscal information and communicate the status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting.
- Professional Development: Meet or exceed production and quality metrics, and work directly with the provider(s) and health plan Medical Director to facilitate quality service to the member and provider.
- Confidentiality and Security: Maintain and keep in total confidence, all files, documents, and records that pertain to the business operations.
- Education and Experience: CA LVN license required, CA RN license preferred. Bachelor's or Master's degree in Social Work, behavioral or mental health, nursing, or other related health field preferred. 3 to 5 years of acute care experience preferred.
- Skills and Abilities: Knowledge of CMS, State Regulations, URAC, and NCQA guidelines preferred. ICD-9 and CPT coding experience a plus. Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel, and experience working in a health plan medical management documentation system a plus. Experience in EZ-CAP preferred. Medical Terminology preferred.
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Clinical Utilization Review Nurse RN
1 week ago
Dubai, Dubai, United Arab Emirates ClickJobs Full timeJob SummaryClickJobs is seeking a skilled Clinical Utilization Review Nurse RN to join our team. As a key member of our Utilization Review and Case Management Department, you will play a critical role in ensuring the quality and efficiency of our healthcare services.ResponsibilitiesUtilization Review: Coordinate and review medical records to assess whether...
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Dubai, Dubai, United Arab Emirates ClickJobs Full timeJob SummaryClickJobs is seeking a skilled Clinical Utilization Review Nurse RN to join our team. As a key member of our Utilization Review and Case Management Department, you will play a critical role in ensuring the quality and efficiency of our healthcare services.ResponsibilitiesMedical Record Review: Coordinate and review all medical records, as assigned...
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Clinical Utilization Review Nurse
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Dubai, Dubai, United Arab Emirates ClickJobs Full timePosition Overview:As a Clinical Utilization Review Nurse, you will play a crucial role in ensuring the quality and efficiency of patient care. Your responsibilities will include coordinating and evaluating medical records associated with your assigned caseload.Key Responsibilities:Review and assess medical documentation to determine the appropriateness of...
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Dubai, Dubai, United Arab Emirates Actalent Full timeJob SummaryActalent is seeking a highly skilled Clinical Review Nurse to join our team in a fully remote role. As a Clinical Review Nurse, you will be responsible for conducting thorough utilization reviews and concurrent reviews of post-acute care services.Key ResponsibilitiesConduct thorough utilization reviews of post-acute care services to ensure medical...
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Clinical Review Nurse Specialist
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Dubai, Dubai, United Arab Emirates Actalent Full timeJob SummaryActalent is seeking a highly skilled Clinical Review Nurse to join our team in a fully remote role. As a key member of our team, you will be responsible for conducting thorough Utilization Reviews and Concurrent Reviews of post-acute care services.Key ResponsibilitiesConduct thorough Utilization Reviews and Concurrent Reviews of post-acute care...
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