Utilization review jobs in Whitestone, NYCreate job alerts

What do we do? Medical Solutions is one of the nation’s largest providers of total workforce solutions in the healthcare industry, connecting nurses and allied health clinicians with hospitals and healthcare systems across the country and around the corner. At Medical Solutions, we’re people who

Minimum of two (2) years utilization review/case management experience or social work experience.

Minimum of two (2) years utilization review/case management experience or social work experience.

Minimum of two (2) years utilization review/case management experience or social work experience.

Minimum of two (2) years utilization review/case management experience or social work experience. Licensed professional nurse may be considered. Commission for Case Management Certification (CCMC) or Association of Rehabilitation Nurses).

Engages in formal and informal peer and institutional review processes. * Collaborates with interdisciplinary teams to create and implement quality improvement projects, evidence-based practice ...

Participate in Utilization reviews and remaining available for emergency consultations. • Analyze the best medications or therapy treatment to help patient maximize quality of life. * Maintain ...

... Review, Discharge Wrap Up, and MD/RN Unit Collaboration. 2. Considers the patient's values, preferences, cultural diversity, expressed needs and knowledge in all aspects of care. 3. Establishes and ...

Actively participates in Quality Assurance/Performance Improvement and Utilization Review activities. * Conducts medical records audits, participates in needs analyses, oversees new/revised practices ...

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

Utilization Management * Participate in utilization review and management. * Maintain focus on key strategic priorities including patient experience, access to care, increased market share, and ...

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

Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System. * Ensures appropriate preparation of lab requisitions for Spectra or alternate lab. * Ensures ...

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

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 ...

... 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 ...

Conducts patient interview, explains policies and procedures to patient/ significant others, reviews patient's chart and answers questions correctly and courteously; assesses gastrointestinal ...

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

Review incoming referrals and update medical chart + medical tracking * Schedule medical appointments * Complete, quarterlies, semi annuals and annual CFAs * Review and update individualized plan of ...

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 ...

Conduct Utilization review via Chart Review. * Conduct timely concurrent reviews and responses to third party payors request for clinical reviews. * Work collaboratively with ED Case Managers and ...

... 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 ...

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 ...

Assess, review, and maintain that daily resident care needs are met, and appropriate resident care is given * Address resident and staff concerns to promote quality care * Supervise staff nurses and ...