Nicegram App Review Jobs in Usa

Summary:

The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• The prior authorization role completes an assessment of a proposed service to determine if the beneficiary has eligible coverage for the service and if it is medically necessary.
• Promote quality, cost-effective outcomes through prior authorization and concurrent review of requested services for medical necessity based upon evidence-based clinical guidelines.
• Identify and present cases of possible quality of care deviations, questionable admissions, and prolonged lengths of stay to the Medical Director for further determination.
• Appropriately refer beneficiaries who have complex or chronic conditions, a need for transition of care, disease management support, or other identifiable needs for coordination of the beneficiary’s member’s health care for behavioral health care management.
• Follow CHRISTUS Health Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI).
• Protect the confidentiality of data and intellectual property;
  assures compliance withnational health information guidelines.
• Analyze clinical information submitted by medical providers to evaluate the medical necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities.
• Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up.
• Utilize the nursing process and critical thinking skills to provide oversight of services and evaluation of service options.
• Ability to work in a variety of settings with culturally diverse communities with the ability to be culturally sensitive and appropriate.
• Must have excellent communication skills (written and verbal), clinical judgment, initiative, critical thinking, and problem-solving abilities.
• Must be able to take after hour calls to meet business requirements as needed.

Job Requirements:

Education/Skills

• Graduate of an accredited school of vocational nursing or equivalent required
• Associate’s (ADN) or Bachelor’s (BSN) in Nursing preferred

Experience

• 3 – 5 years of nursing experience preferred
• Experience in Microsoft software (e.G., Outlook, Teams, Word, and Excel) required
• General computer knowledge and capability to use computers required

Licenses, Registrations, or Certifications

• LVN license in the state of employment or compact required
• RN license in state of employment or compact preferred

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

Position Title APP Acute Care Trauma- Weekends Bell Hospital Position Summary / Career Interest: Schedule Options: Fri- Sun or Sat-Mon The Advanced Practice Provider (APP) APRN Trauma Surgical manages health problems and coordinates health care for Surgical patients in acute care or in-patient settings for pre- or post-surgical patients in the Trauma program or service line.

These APPs deliver patient care and medical services to individuals and families by utilizing standards of care in accordance with State and Federal rules and regulations to assess health status, diagnose medical conditions, develop medical plan of care, implement treatments and evaluate patient responses in collaboration with collaborative/sponsoring physician as described in a Collaborative Practice Agreement.

Responsibilities and Essential Job Functions Able to evaluate medical problems of clients in the assigned practice setting and appropriately requests consults to other specialties when indicated.

Provides education to patients and/or families about preventive care, medical issues and use of prescribed medical treatments and/or medications pertinent to the neonatal patient's condition.

Creates diagnostically appropriate treatment plans Documents all medical evaluation, diagnoses, procedures, treatments, outcomes, education, referrals and consultations consistent with NCQA, The Joint Commission, state regulatory standards and evidenced-based standards of care.

Maintains documentation compliance for appropriate coding and billing.

Facilitates evaluation of records by physician(s), peers and quality standards according to protocols and receives and implements constructive directives.

May refer complex and high priority cases to collaborating physician with regards to complicated diagnostic problems, serious illness, complicated therapeutic problems and re-evaluation of chronic conditions.

Provides medical and emergency interventions appropriate to the client's needs; prescribes and monitors medications appropriate to the diagnosis; orders and monitors the appropriateness of emergency interventions.

Maintains collegiality with all members of the inter-disciplinary team.

Utilizes appropriate chain-of-command and communicates with specialty practice Program Director, APP Director and Medical Director of any clinical issue and contributes to quality improvement or process improvement as necessary.

Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.

These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities.

Skills and duties may vary dependent upon your department or unit.

Other duties may be assigned as required.

Required Education and Experience Master's Degree in Physician Assistant OR Master Degree Nursing from an accredited program in Advanced Practice Nursing for APRNs OR Doctor of Nursing Practice from an accredited program in Advanced Practice Nursing for APRNs Age appropriate training for "population served" may depend on APRN/PA program training and may require additional training as determined by the department Preferred Education and Experience Previous APRN or PA experience Required Licensure and Certification Licensed Physician Assistant (PA)
- State Board of Healing Arts copy of the current PA license for the State of Kansas and/or Missouri (depending on practice locations) OR Advanced Practice Registered Nurse (APRN)
- State Board of Nursing copy of the current APRN license for the State of Kansas and/or Missouri (depending on practice locations) Basic Life Support Heartsaver (BLS HS) (Non-Clinical)
- American Heart Association (AHA) Advanced practice certification required.

APRNs may obtain within one year of date of hire; Specific certification may be required depending on specialty Time Type: Full time Job Requisition ID: R-46411 Important information for you to know as you apply: The health system is an equal employment opportunity employer.

Qualified applicants are considered for employment without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, ancestry, age, disability, veteran status, genetic information, or any other legally-protected status.

See also Diversity, Equity & Inclusion .

The health system provides reasonable accommodations to qualified individuals with disabilities.

If you need to request reasonable accommodations for your disability as you navigate the recruitment process, please let our recruiters know by requesting an Accommodation Request form using this link .

Employment with the health system is contingent upon, among other things, agreeing to the health-system-dispute-resolution-program.pdf and signing the agreement to the DRP.

Need help finding the right job? We can recommend jobs specifically for you! Create a custom Job Alert by selecting criteria that suit your career interests.

Conducts comprehensive clinical reviews of adverse determinations related to medical necessity.

Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making.

Provides support for claim appeals in relation to medical necessity.

Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards.

Facilitates member second level appeal process.

Graduate from an accredited school of professional nursing is required.

BSN preferred.

Minimum 2 years acute care experience or managed care experience is required.

Basic knowledge of Medicaid, Medicare preferred.

Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.

Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.

Active Certification in Case Management (CCM) is preferred.

Why Deliver with DoorDash?

DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day. As a Dasher, you’ll stay busy with a variety of earnings opportunities and can work when it works for you. Whether you’re looking for a side hustle or a full-time gig, delivering with DoorDash gives you the opportunity to earn extra cash on your terms.

• Multiple ways to earn:Whether you’re delivering meals, groceries, or retail orders, DoorDash offers diverse earning opportunities so you can maximize your time.
• Total flexibility:Dash when it works for you. Set your own hours and work as much—or as little—as you want. 
• Know how much you'll make:Clear and concise pay model lets you know the minimum amount you will make before accepting any offer.
• Instant cash flow:Get paid the same day you dash with DoorDash Crimson*. No deposit fees, no waiting.
• Quick and easy start:Sign up in minutes and get on the road fast.**
• Simple Process:Just pick up, drop off, and cash out. Payday is in your back pocket.

Basic Requirements

• 18+ years old*** (21+ to deliver alcohol)
• Any car, scooter, or bicycle (in select cities)
• Driver's license number
• Social security number (only in the US)
• Consistent access to a smartphone

How to Sign Up

• Click “Sign UpApply Now” and complete the sign up process
• Download the DoorDash Dasher app and go

*Subject to eligibility requirements and successful ID verification. The DoorDash Crimson Deposit Account is established by Starion Bank, Member FDIC. The DoorDash Crimson Visa® Debit Card is issued by Starion Bank.

**Subject to eligibility..

***Must be 19+ in Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Kentucky, Montana, New Jersey, New Mexico, Texas, Utah, and West Virginia

Additional information

Dashing with DoorDash is a great earnings opportunity for anyone looking for part-time, seasonal, flexible, weekend, after-school, temporary, steady delivery gig. Deliver with DoorDash and earn extra cash while being your own boss. Dash when it works for you. Sign up today.

The Upfront Review Clerk is responsible for the quality review of all pertinent customer information for accuracy and completeness in order to meet payer requirements for timely and maximum reimbursement.

Responsibilities include:

• Evaluating all received documents to ensure that appropriate information has been obtained to allow for successful Accounts Receivable
• Maintaining Held Sales by assisting customer service representatives weekly in correcting problems so billing may begin or continue
• Responsible for reviewing various reports for quality assurance
• Recording all activity relating to the account in tickler files