Conducts and oversees treatment record and case management record reviews. Trends and analyzes findings for internal and external reporting. Reviews charts and analyzes clinical record documentation. Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. Collects, analyzes and prepares clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services. Prepares monthly performance reports. Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and other clinical staff. Provides training, interpretation and support for QI Clinical Reviewer staff. Audits and validates internal audit results and/or corrective action plans. Requires RN/BSN or clinical credentials in a behavioral health field. If not an RN, must hold Masters or Doctoral Degree and be a licensed behavioral health professional. Good organization, time management and verbal and written communication skills. Knowledge of utilization management procedures, Medicaid benefits, community resources and providers. Knowledge and experience in diverse patient care settings including inpatient care. Ability to function independently and as a team member. Knowledge of ICD and DSM IV coding or most current edition. Ability to analyze specific utilization problems and creatively plan and implement solutions. Ability to use computer systems. 7 or more years of experience post degree in a clinical, psychiatric and/or substance abuse health care setting. Minimum of 4 years of experience conducting utilization management according to medical necessity criteria.
By applying, you consent to your information being transmitted by Jooble to the Employer, as data controller, through the Employer’s data processor SonicJobs.
See Sonicjobs Privacy Policy at and Terms & Conditions at and SonicJobs Privacy Policy at and Terms of Use at
...will help to support the successful operation of the companys contracting and capture functions. This role reports to the companys... ...development in accordance with customer requirements and current government regulations, laws, and company policies. Position...
...facilities, U.S. citizenship is required.Responsibilities for this Position Put your engineering talent to the ultimate test. At General Dynamics Mission Systems, we create the technologies, products and services that help our service members, intelligence analysts and...
...This is a fully remote position, work from the comfort of your home office space. Life Line... ...Screening is seeking Remote Inside Sales Representative to join our innovative healthcare... ...: Handle 35-45 incoming calls per shift Collect health information...
...our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire... ...e.g., Community Health Worker, Peer Support Specialist, Medical Assistant, etc.). High school diploma or GED required. A valid driver...
...year (Base + Uncapped Commission) Full-time | Outside Sales | Paid Training | Growth Opportunity About Grapevine Pro Grapevine... ...motivated individuals to join our Entry-Level Sales Teamno sales experience required! Well teach you everything you need to succeed and...