Utilization review jobs in Bayonne, NJCreate job alerts

Based on a comprehensive review of the client's overall condition, prepares, continually reviews and evaluates plans of nursing intervention to ensure that such interventions are consistent with the ...

... on proper utilization of those medical devices. * Supervise procedures for students taking ... Review and maintain accurate and current health records in accordance with local governmental ...

Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and ...

Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift, night shift, and mid shift Job types available: full time, part time, and per diem Employer features: 401(K) ...

Complies with infection control practices such as hand washing, proper utilization of PPE, etc ... Reviews work que/email of abnormal findings from radiologist. * Make appointment for follow -up ...

A minimum of two years experience performing utilization review, claims adjudication, medical review, fraud investigation, surveillance or monitoring activities, required; OR * Three years of ...

... review, etc., following established MetroPlusHealth Utilization Management policies, procedures, and protocols. - Oversee the coordination and delivery of comprehensive, quality healthcare and ...

Participate in utilization and peer review programs which evaluates the quality of the medical staff and medical services being performed at the clinics * Provide supervision and consultation to ...

Review Patient medical documentation * Setup communication to assist patient enrollment into managed care plans * Performs other duties that may be assigned Qualifications: * New or Previous ...

Applications will be reviewed on a rolling basis until the position is filled. The mission of the ... Optimize resource allocation and utilization to ensure efficient and effective product operations

... to ensure optimal utilization of services. * Ensure quality standards set by the external ... Provide ongoing review of emergency equipment, biological and medications in order to maintain ...

Participates in helping to review and develop medical guidelines and policies geared toward quality ... Previous Utilization Management Experience in Acute Care Setting * Prior leadership experience ...

Utilize evidence-based strategies to prevent hospitalization and inappropriate ER utilization ... Review and authorize service requests according to workflows and timelines. * Collaborate with ...

The position also involves reviewing outcomes, coding, and utilization data to enhance participant health and reduce unnecessary utilization. Benefits * Medical, Vision, Dental, and Life Insurance

... and utilization of referral services, as part of the health care system. Assists in providing ... Reviews and analyzes trends pertinent to delivery of nursing care services and collaborates with ...

Review and interpret screening and diagnostic observations and report findings to the project ... Familiarity with database utilization, regulatory compliance and human subject's protection issues

Develop, implement and evaluate case management programs, including utilization review, and discharge planning. * Establish and maintain relationships with community-based services and organizations ...

Job Summary: • Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business. • Develop a working relationship with the PCP to be able to contact and ...

Assess appropriate site of care utilization and continued medical necessity reviews for prior authorization to vendors. * Ensure communication with MD offices in relation to Site of Care program

Review and update medication list to ensure accurate and complete list in electronic medical record (EMR) available for provider review and submission. Complete referrals and tracks patients ...

Review and update medication list to ensure accurate and complete list in electronic medical record (EMR) available for provider review and submission. Complete referrals and tracks patients ...

Reviews complaints and grievances made or filed by staff. Makes appropriate reports to the Nursing Manager/charge nurse as required or as may be necessary. * Ensures that staff participates in and ...

This plan should be reviewed and revised as needed. * Integrates therapeutic intervention techniques into programs or home of person served through consultation with parent/guardian and staff at team ...

Visits each assigned home weekly (minimally) to provide nursing oversight and complete review of items. * Interacts with primary, medical specialists, various clinical staff as necessary. * Advocate ...