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.
...Medical and Cosmetic Dermatology Nurse Practitioner Job Opportunity in Jackson, NJ Job#16671220 Be part of a cutting-edge dermatology practice with advanced technology. Treat acne, rosacea, and other common skin issues. Administer injectables and fillers. Experience...
Inside Sales Representative - Fire Protection Job Description Seeking an Inside Sales Representative. Responsibilities include selling and promoting our products and services to new and existing customers; generating new business; presenting and demonstrating ...
We have an opportunity for a talented Leisure Travel Agent with Apollo GDS skills that resides in Sarasota, FL area. Skills needed... ...GDS proficiency Knowledgeable of Luxury travel products International travel destination experience Strong sales skills...
...Training Manager Role At Chick-fil-A De Zavala, the Restaurant Training Manager role is more than just a job its an opportunity to lead, coach, and shape the growth of our team. We are committed to more than great food we create a positive, people-focused...
...Program is 9-weeks long and we select a group of highly motivated summer interns with the goal of identifying talent for our Full-time Analyst... ...the firm (Asset Management, Acquisitions, Capital Markets, Accounting, Legal, Treasury, Design, )~Assist with ad-hoc projects and...