Sentences with phrase «care utilization management»

I also have a background in Managed Care Utilization Management for Outpatient and Residential levels of care.

Not exact matches

Summary: Registered Nurse for 30 years with extensive background in Case Management, Utilization Review, Skilled Care Home Car...

Main job duties and responsibilities seen on a Utilization Management Nurse resume sample are reviewing patient clinical information, monitoring staff, advocating quality care, finding ways to prevent patient complications, and maintaining accurate records of patient interactions.

Create Resume More than 14 years» diverse leadership experience as a physician executive with significant accomplishments in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs and coaching medical staff on healthcare business and practice issues.

Tags for this Online Resume: Registered Nurse, Utilization Management, Call Centers, Occupational Health, Microsoft Office Suite, Managed Care, Process Improvement, Training and Development

Possess over 25 years diverse nursing background, 15 years Hospital and Managed Care Case Management / Utilization Management.

Registered Nurse for 30 years with extensive background in Case Management, Utilization Review, Skilled Care Home Care, Personal Care and Hospice Home Care.

Tags for this Online Resume: Inventory, Insurance, Management, Clinical Programs, Pharmacist, Pharmacy, Managed Care Organization, Pharmacy Benefit Management, Pharmaceutical, Prior Authorization, Drug Utilization Review, Medication Therapy Management

IT, utilization of clinical skills and knowledge in case management, Quality Improvement, documentation, case management, education in home health care and hospice re care management, care planning, software etc

• Knowledge and experience in the design, implementation and analysis of health care quality and cost data studies for quality improvement and appropriate cost - containment, resource utilization analysis, physician profiling, HEDIS, NCQA and QARR reporting • Microsoft Office Professional Suite (Word, Excel, Access, Outlook) • Proficient in application of Utilization Management Guidelines, including Milliman, Robertson anutilization analysis, physician profiling, HEDIS, NCQA and QARR reporting • Microsoft Office Professional Suite (Word, Excel, Access, Outlook) • Proficient in application of Utilization Management Guidelines, including Milliman, Robertson anUtilization Management Guidelines, including Milliman, Robertson and InterQual

Tags for this Online Resume: Amazon Elastic MapReduce, EMR /, HIV Clinics, Home Health / Public Health, Immunization, Wound Care / Wound Vac, Behavioral Health, Cardiopulmonary resuscitation (CPR), Chronic Diseases, CENTRAL LINES, Case Management, Utilization Review

Longtime health care professional with in - depth, versatile experience establishing and managing programs such as risk management, performance improvement, education, infection control, utilization review and case management.

Tags for this Online Resume: Documentation, Basic Care, BASIC Programming Language, First Aid, Insurance, Medical, Medical Records, Occupational Therapy, Team Player, Therapy, Utilization management, Facility Site Review, Advanced Imaging, HEDIS, Case Management, Patient Advocates, Medi - Care, Medicaid, Healthcare insurance company, Quality Assurance and Improvement, ICD, CPT coding, Insurance Health plan Collaboration, Problem resolution and Solution distribution, outpatient rehabilitation, nurse, healthcare, outpatient physical therapy, physical therapy, physicalmanagement, Facility Site Review, Advanced Imaging, HEDIS, Case Management, Patient Advocates, Medi - Care, Medicaid, Healthcare insurance company, Quality Assurance and Improvement, ICD, CPT coding, Insurance Health plan Collaboration, Problem resolution and Solution distribution, outpatient rehabilitation, nurse, healthcare, outpatient physical therapy, physical therapy, physicalManagement, Patient Advocates, Medi - Care, Medicaid, Healthcare insurance company, Quality Assurance and Improvement, ICD, CPT coding, Insurance Health plan Collaboration, Problem resolution and Solution distribution, outpatient rehabilitation, nurse, healthcare, outpatient physical therapy, physical therapy, physical therapist

Core Competencies Case Management • Utilization Review • Plan Development • Condition Code 44 • Operations Management • Patient Relations • Healthcare Services • Business Development • Program Development Recruitment & Training • Budgeting • Medical Instruction • Medical Assistance • Patient Care Placement Team Leadership • Operations Improvement • Communications • Program Management

Director of Business — Duties & Responsibilities Recruit and train staff of 30 in hospital policies, procedures, best practices, and corporate branding Design and implement staff development, recognition, and disciplinary policies and procedures Oversee admissions, utilization review, PB X, imaging center, billing, collections, and wound center registrations Set and strictly adhere to departmental budgets and schedules Author and present financial reports concerning revenue, expenses, and outstanding collections Identify performance indicators and benchmarks for integration into reporting systems Conduct surveys regarding patient / staff satisfaction, benchmarks, accreditation, and employee benefits Maintain a 99 % patient satisfaction score through attentive and professional standards of care Negotiate contracts and claims with insurance carriers, Medicare, Medicaid, and other payer sources Increase revenue by 30 % through effective contract renegotiation with suppliers, carriers, and other parties Implement policies, procedures, and equipment to cut hospital costs while enhancing patient care Utilize strong management experience to drive operations in an efficient and professional manner Develop and implement billing controls, cash processing measures, lockboxes, and other financial processes Coordinate and oversee internal and external audits ensuring compliance with industry and legal standards Recruit physicians through successful marketing, networking, and other tactics Implement automated Chargemaster financial application (Craneware) and maintain patient accounts Responsible for HCAHPS and the yearly Quality Assurance Plan Appeal claims when appropriate resulting in $ 400,000 reimbursement from PPO insurance over the last year Build and strengthen professional relationship with community leaders, coworkers, and industry figures Consistently promoted for excellence in financial management, team leadership, and dedication to mission Develop working knowledge of hospital operations from patient admission to senior level strategic planning Represent company with poise, integrity, and positivity

An example of a robust case management initiative is Health Leads, 77 an enhanced primary care strategy that uses college volunteers as advocates and advanced resource management techniques, which has improved coordination of care and utilization of collocated social services by low - income families with the intent of reducing the social barriers to good health.

This trial demonstrated that 1 year of dialectical behavior therapy or general psychiatric management for the treatment of suicidal patients with borderline personality disorder brought about significant reductions in suicidal behavior, borderline symptoms, general distress from symptoms, depression, anger, and health care utilization, along with improvements in interpersonal functioning.