Sentences with phrase «utilization review experience»

Tags for this Online Resume: Case Manager, computer and Internet literate, Utilization review experience, Organized, CPR certified, Motivation interviewing techniques, Chronic condition management, Leader

3 - 5 years of recent clinical experience required; nursing experience and utilization review experience highly desired.

Not exact matches

I have also done investigation for healthcare fraud and have experience in utilization review.

A minimum of 3 years of experience in a Nurse Case Manager or Utilization Review Nurse position with experience in quality strongly preferred...

This is sample resume through which the candidate is displaying her skills and experience of working with a hospital as an utilization review nurse.

Tags for this Online Resume: drug utilization review, JCAHO, organizational skills, compliance with regulatory agency regulations, performance improvement, patient safety, Medicare, Medicaid, Consultant Pharmacist, Hospital, Assisted Living Facility, Nursing Home, Skilled Nursing Facility, Intermediate Care / Mentally Retarded Facilities, Memphis, TN, 15 years experience, TN state license in good standing, PharmD

To obtain a challenging nursing position in Case Management / Utilization Review / Occupational Health Nurse where my nursing experience, skills and abilities may be utilized to become and important asset to the organization.

Dedicated, knowledgeable, and extremely proficient Human Services professional with more than 20 years experience, demonstrating expertise in case management, utilization review, relationship management, and cost containment strategies in state and hospital environments.

Licensed Physician and Surgeon with 24 + years of comprehensive experience in multiple fields of medicine: General Medicine, Sports Medicine, Occupational Medicine, Urgent Care Medicine, Utilization Review, Phlebology and Medicolegal Consulting.

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.

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

Professional Experience Qualis Health (Boise, ID), Director of Idaho Medicare Operations 2007 — Present Qualis Health (Boise, ID), Project Manager 2003 — 2007 Cascade Medical Center (Cascade, ID), Director of Operations & Healthcare Services 2001 — 2003 Shepard's Home, Inc. (McCall, ID), Executive Director 1999 — 2001 Independent Consultant (CA & ID) 1992 — 1999 CIGNA (San Diego, CA), Director of Provider Relations & Director of UM / QA 1985 — 1991 Sharp Memorial Hospital (San Diego, CA), Managing Director Utilization Review 1984 — 1985 State of California, Department of Mental Health (Sacramento, CA) Health Care Services Nurse; Mental Health Specialist II 1980 — 1984 Greater Sacramento PSRO (Sacramento, CA), Registered Nurse 1977 — 1980 Sacramento Community Hospital (Sacramento, CA), Registered Nurse 1976 — 1977 St. Benedict's Hospital (Jerome, ID), Registered Nurse 1969 — 1975