Sentences with phrase «utilization review»
Utilization review refers to the process of evaluating how effectively something is being used or utilized. It involves assessing and reviewing the use of resources, services, or systems to determine if they are being used efficiently and for their intended purpose. Full definition
The job outlook for utilization review managers is positive.
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The services that utilization review nurses provide to insurance companies, medical facilities, and patients help in keeping the healthcare industry free of any problems.
Continue working within the area of utilization review while using my nursing experience and clinical skills that I have already honed.
I have also done investigation for healthcare fraud and have experience in utilization review.
3 - 5 years of recent clinical experience required; nursing experience and utilization review experience highly desired.
We provide ongoing program utilization feedback, including monthly data reports and annual utilization reviews.
Crossroads Treatment Centers is seeking an Administrative Utilization Review specialist to join our OTP clinic in Suffolk, VA..
• Skilled at using case management software, navigate Medical web services and use Interqual and Millman criteria for utilization review.
Humana, a leading name in health insurance providers, is accredited by URAC (Utilization Review Accreditation Commission) and NCQA (National Committee for Quality Assurance).
Registered Nurse RN Utilization Review Case Manager FT Days Work Hours / Shifts Full Time Days Florida Hospital Memorial Medical Center - Daytona Beach FL Top Reasons why you want to work at Florida...
Our market differentiation includes drug utilization review at Point of Care (PoC) and Point of Sale (PoS), medication therapy management (MTM), medication adherence management (MAM), coverage gap prediction and prescription planning, optimize untapped generics usage, prevent adverse drug events (ADEs), fraud, waste and abuse management, advanced analytics and cost management, and effective specialty pharmacy management.
King v. CompPartners, Inc.: (1) Is a claim by an injured worker for medical malpractice brought against a workers» compensation utilization review company barred by workers» compensation as the exclusive remedy?
Acute hospital concurrent and retrospective utilization reviews and discharge planning using Interqual criteria to determine appropriate levels of care and readiness for discharge to lower levels of care.
Provided comprehensive Utilization Review, prospectively, concurrently or retrospectively utilizing cost containment strategies
Appealed before Connecticut Supreme Court an issue of first - impression regarding reasonableness of utilization review criteria used to make medical necessity decisions for Medicaid recipients in the early prevention, screening, diagnosis and treatment (EPSDT) program.
* Consults and support the Case Management and Utilization review persons.
Retail Pharmacy Operations Drug Utilization Review Final Quality Assurance Checks Inventory Control Vendor Negotiations Pharmacy Marketing and Promotions Patient Counseling Pharmaceutical Research MedE America Pharmacy System
A general acute care hospital in Texas resolved a Stark violation involving an arrangement with a physician to provide utilization review services that did not satisfy any applicable exception.
In a scathing indictment of the over-reaching effects of ERISA preemption, Judge William Young of the United States District Court for the District of Massachusetts implored Congress to amend ERISA's civil enforcement provision to allow recovery against utilization review providers and insurers.
Collaborate with the client's existing utilization review, case management, and member services staff to ensure appropriate resource allocation and utilization by all members
Responsible for weekly Utilization review to ensure that nursing documentation met all state guidelines.
Prior Authorization / Pre-certification / Utilization Review Registered Nurse / RN / R.N. / Nurse Overview HCS Healthcare is currently partnered with a healthcare system, actively interviewing for a...
Utilization Review Manger competent at assuring the receipt of high quality and cost efficient medical outcomes.
API is looking for a temporary Part Time Utilization Review Case Management Clerk to join our team.
The Director will oversee a staff of around 6 people including Utilization Review Coordinators, billing specialists and eligibility specialist.
* Performs clinical duties under direct supervision of a licensed pharmacist, including medication reconciliation, adverse drug event reviews, renal dosing, medication utilization reviews, patient rounds with physicians, presentations for education purposes, and other clinical duties as directed by preceptor.
I do Utilization Review with the insurance companies and keep them updated on the patients progress.
Assisted in obtaining company certifications including URAC Utilization Management Accreditation, New York State Utilization Review Agent Certification and DS Certification.
Processing utilization reviews to determine if criteria was met for the services being requested or sending cases for MD review if criteria not met during the initial review.
HCA, Regional Medical Center, San Jose • CA Assistant Director Case and Resource Management 2010 — Present Utilization Review / Case Management 2006 — 2010
A hospital in New Jersey is actively seeking a licensed Registered Nurse (RN), with a strong Utilization Review background,...
Erica has also worked in managed care, providing utilization review for a major health insurance company.
Coordinated quality management and utilization review on daily basis with Interqual and AS 400, and compiled statistics for presentations to State for case - by - case review.
This cover letter was written by ResumeMyCareer's staff of professional resume writers, and demonstrates how a cover letter for a Case Management — Utilization Review Oversight Cover Letter Sample should properly be created.
A minimum of 3 years of experience in a Nurse Case Manager or Utilization Review Nurse position with experience in quality strongly preferred...
At 9 a.m., the state Department of Health's Drug Utilization Review Board meets, Empire State Plaza, concourse level, Meeting Room 6, Albany.
Nursing Professional possessing in - depth knowledge of utilization review, care / case management and nursing principles.
Tags for this Online Resume: Utilization Review Case Manager, Case Manager, Disease Case Manager, Registered Nurse, Clinical Educator, Medicare and Medicaid, Care Coordinator, Health administration, Immunization, RN