Medical Services Nurse Staff
2 weeks ago
Utilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan.
Prior authorization that allow payers, particularly health insurance companies to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines. Strong utilization management process can reduce payment denials.
Clinical documentation specialists is designed to improve the physician's documentation in the patient's medical record, supporting the appropriate severity of illness, expected risk of mortality and complexity of care of the patient.
Clinical documentation is responsible for extensive collaboration with physician is, nursing staff, support staff, other patient caregiver and medical records coding staff.
Employee insurance liaison
Meadville Medical Center has self-funded insurance. One staff member is assigned to work with Human resources, Highmark Liaison, Medical director and employees. Set process is to call medical procedures out of network and employee needs to request a waiver from our current liaison. The liaison will review the requested procedure with our current medical director. br>
Medical necessity rules will be reviewed, urgency and medical history. They will review with the medical director and make a decision to override the out of network rules.
Committed to life-long learning
UM Process
- Payors may use different criteria and may require their data set be applied for their population.
- Utilization management is a strategy for managing cost and quality under the latest CMS reimbursement
- Reviews precertification requests for medical necessity, referring to the Medical Director those that require additional expertise.
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Medical Services Nurse Staff
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Medical Management Director
6 days ago
Meadville, Pennsylvania, United States Meadville Medical Center Full timeJob SummaryThis leadership role is responsible for overseeing the utilization management department at Meadville Medical Center.Directly report to the Vice President of Revenue Cycle Services and provide strategic guidance on department operations.Schedule staff effectively to ensure optimal performance and productivity.Approve all timecards for the UM...
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REGISTERED NURSE
3 months ago
Meadville, United States Meadville Medical Center Full time$5,000 SIGN ON BONUSUtilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan.Prior authorization that allow payers, particularly health insurance companies to manage the cost of health care...
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REGISTERED NURSE
3 months ago
Meadville, United States Meadville Medical Center Full time$5,000 SIGN ON BONUSUtilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan. Prior authorization that allow payers, particularly health insurance companies to manage the cost of health care...
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REGISTERED NURSE
3 months ago
Meadville, United States Meadville Medical Center Full time$5,000 SIGN ON BONUSUtilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan. Prior authorization that allow payers, particularly health insurance companies to manage the cost of health care...
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REGISTERED NURSE
3 weeks ago
Meadville, United States Meadville Medical Center Full time$5,000 SIGN ON BONUSUtilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan.Prior authorization that allow payers, particularly health insurance companies to manage the cost of health care...
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Medical Support Assistant
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Nursing Care Coordinator
6 days ago
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Registered Nurse
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Registered Nurse
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REGISTERED NURSE
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REGISTERED NURSE
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Meadville, United States Meadville Medical Center Full time*SIGN ON BONUS- $5,000 LPN / $1,000 CMA * JOB SUMMARYProvides all necessary services needed to assist hospice patients to live in the Marquette Hospice House, becoming part of the Hospice team to carry out the patient's plan of care.JOB DUTIESProvides direct care to guests (hospice patients) who live in the home.Assist in the facilitation of smooth patient...
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Medical Doctor
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MEDICAL ASSISTANT
7 days ago
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LICENSED PRACTICAL NURSE
3 months ago
Meadville, United States Meadville Medical Center Full time$2,500 SIGN ON BONUS!JOB DUTIESReports pertinent observations, changes, and reactions regarding patients to the appropriate person.Notifies team leader, charge person and/or physician of observations regarding patients.Documentation on patient record of observations, changes and reactions and the reporting of them to the appropriate person.Communicates...
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