Job Title
Experience: 3 years Required, Any Preferred Preferred Preferred Yes
Certs marked with * are preferred BLS Skills marked with * are preferred
Work Settings:
- Acute Hospital
- Long Term Acute Care/Rehab/Skilled Nursing
Case Management/Utilization Review:
- Admission Criteria
- Care coordination
- Discharge Planning
- Utilize InterQual Criteria
- Utilize Milliman Guidelines
Utilization Review:
- Admission Criteria Appeals and Denials
- Concurrent Review
- Continued Stay Reviews
- Medical Necessity
- Retrospective Review
- Utilize InterQual Criteria
- Utilize Milliman Guidelines
Regulatory:
- CMS: Centers for Medicare and Medicaid Services
- CPT (Current Procedural Terminology) coding and billing
- Department of Health
- DRG (Diagnosis Related Groups)
- HEDIS (The Healthcare Effectiveness Data and Information Set) Measures
- HIPAA guidelines (Health Insurance Portability and Accountability Act)
- ICD 10 Coding
- NCQA (National Committee for Quality Assurance)
- OSHA
- The Joint Commission/Core Measure/National Safety Goals
- Workers Compensation
Unit Details:
- Block
- Days: - Nights: - Weekends: -
- Yes Note: Within facility/scope of practice as needed
