Utilization review jobs in Englewood, NJCreate job alerts

Minimum Qualifications NYC Children's Center is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and efficiency of psychiatric and medical services ...

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 ...

Position Summary Performs concurrent utilization review activities on all patients within the assigned caseload. Collaborates and educates the medical staff on appropriate utilization review ...

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 and mid shift Job types available: full time, part time, and per diem Employer features: Cross training ...

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

Coordinate with Utilization Management (UM) department on concurrent and retrospective review. Follow up with assigned nurses for clinical updates to care plan. Document within two business day ...

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 ...

... 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 ...

Participate with materials management in the review and selection of all specialty supplies, dressings, and materials for wound and ostomy care to facilitate cost-effective utilization and compliance ...

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

... 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 ...

... 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

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 ...

Adheres to and participates in the agency's utilization management model. License Requirements * Current RN licensure in state of practice * Current CPR certification * Current Drivers License ...

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 ...

NURSING ● Registered Nurses (RN) ● Licensed Practical Nurses (LPN) ● Travel Nursing ● Quality Assurance/Review, Performance Improvement, HEDIS ● Nursing Leadership ● Case Management ...

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 ...

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 ...

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 ...

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 ...