Required 2 years of experience in an acute care clinical setting with general nursing exposure in utilization management to include pre-authorization, utilization review, concurrent review, discharge planning, and/or case management with review.
February 12, 2020
Performs comprehensive and accurate documentation to ensure grievances are handled in accordance to CMS guided regulations.
February 23, 2020
Reviews all surgery cases across BHSF pre and post procedure to ensure appropriate CPT, LOC, Relevant testing, authorization and medical necessity is present in the EMR prior to billing.
March 08, 2020
Utilize industry guidelines, Medicare Benefit Policy Manual guidelines, national coverage determinations, local coverage determinations, and best practice standards, as well as a broad knowledge base and sound clinical judgment in reviewing medical records and writing appeals.
March 22, 2020
Prepares clinical reviews based on clinical guidelines and provides monitoring of cases involving medical decisions and quality of care or service decisions.
April 13, 2020
Participates in on-going training programs to ensure quality performance is in compliance with applicable standards and regulations.
April 23, 2020
Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
May 05, 2020