Participated in multi-disciplinary case management/discharge planning at community hospitals for hospitalized active duty members. Facilitated acquisition of needed durable medical equipment and supplies for home care and coordinated follow-up appointments. Developed standard of practice and competencies for telephone triage and supervised assigned staff. Candidate Info 9 Case manager / Utilization review Nurse determined medically necessary levels of care through on site concurrent review. Authorized appropriate and cost effective level of services. Proactively educated physicians and patient/caregivers regarding vendor and community service resources. Coordinated in-home services post hospital discharge.
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Maintained statistical records and writers quarterly reports as required. Represented Utilization review Department on various committees within scf and with external partners. Candidate Info 8 Case manager / Utilization review Nurse family Practice staff nurse for 4 physicians providing care to nature over 2,000 active duty personnel and their families. Some areas of responsibility included the management of immunizations; routine care; medication refills; referral to specialty clinics; assisting with minor procedures; scheduling; depo-medrol clinic; blood draws and patient education. Obtained required credentials as a certified Professional in Utilization review, developed the program, provided training to physicians and other clinic staff then implemented Utilization review and Case management programs for the clinic. Instrumental in the successful transition of the military healthcare system for active duty personnel from Supplemental Medicine paid by active duty commands to the new TriCare healthcare system. Liaison with new network providers and hospitals to ensure correct contact information available to them to facilitate Utilization review and timely processing of claims for payment. Conducted prior-approval first level review for all requested out-patient testing and specialty review consults for active duty personnel. Conducted stay reviews for all active duty personnel hospitalized in the community and facilitated transfer to military hospitals when indicated. Participated in multi-disciplinary patient case management at the clinic level.
Analyzed member records to ensure compliance with government and year insurance company reimbursement policies. Determining member review dates according to established diagnostic criteria. Maintained utilization review logs as needed and created reviews to send to medical director. Perform administrative duties; create spreadsheets to log daily activities and other documents as assigned Candidate Info 6 Utilization review Nurse perform, monitor, and determine medical necessity reviews on inpatient and outpatient healthcare services ensuring health care services being performed in the appropriate setting Ensure effective. Provided hospital pre-certification and concurrent medical record reviews to determine appropriateness of admissions, procedures and length of stays. Provided non-inpatient case reviews to determine the medical necessity and appropriateness of treatment plans, ratings and Out-Patient Services. Collaborated with multidisciplinary teams. Reviewed medical records for icd 9, cpt and drg. Certified acute hospital length of stays as medically necessary.
Attended conferences to refine skills for oasis professional correlation with icd-9 coding. Candidate Info 4, utilization review Nurse, evaluated and authorized medical necessity of services. Prepared reports and documentation for monthly board meetings. Prepared and submitted monthly ipa reports for delegation audits. Provided supervision in operating an ipa/POD. Monitored and insured productivity and performance. Candidate Info 5, utilization review Nurse/lpn, medicaid Managed Care, reviewed nj choice and pca tool for members to decipher medical necessity.
Candidate Info 3, utilization review Nurse, managed comprehensive chart audits for Additional Documentation Requirements (ADR) for Fiscal intermediary review, adverse events review, and error report review for process improvement. Conducted oasis review to assess appropriateness of documentation for 485 document preparation and icd-9 diagnosis Coding. Verified compliance with Agency policy and Procedure, state, jcaho, and Hem 11 guidelines. Managed various insurance audit reviews and subpoena audits for payer inquires. Conducted Medicaid/MediCal care management pre-authorization an treatment authorization requests. Conducted peer review preparation, facilitated peer review meetings, and assessed data collection of review findings. Trained and oriented new staff members in learning oasis documentation procedures.
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Assisted and/or provided facility interdisciplinary teams benefit information for in network providers/facilities, dme, home healthcare, acute, sub-acute rehab, skilled nursing facilities, and out-of-network benefits, if needed. Communicated frequently with assigned case managers for unplanned admissions, inpatient status, and discharge plan with orders. Collaborated with assigned case manager to identify members frequent hospital readmissions. Participated in weekly um grand rounds with plan liaison, medical director, urns and Alere oncology lpn medical director. Candidate Info 2, utilization review Nurse, reviewed high volume case load of patient charts to determine medical necessity based on nursing knowledge and state mandated guidelines. Dealt one on one with numerous doctors and patients daily regarding medical treatments.
Answered a busy phone line to educate and explain treatments ordered. Spoke with insurance agents regarding icd-9 and cpt codes. Collected documentation from numerous providers to add to patient medical history chart. Performed duties in accordance with well-established rules, procedures, regulations, principles and operations covering patient medical records, their required contents, establishment and maintenance of special registries, documentation of incidents, most and diagnostic coding requirements and procedures. Utilized knowledge of an extensive body of well-established medical records procedures, rules, processes, company and legal policy for multiple states and areas of responsibility; to include establishing, coding, maintaining, and disposing of patient medical records.
You will receive a confirmation soon. Email: Resume: Browse Upload Resume file. Utilization review Nurses review patient cases and ensure that the patient is receiving the proper treatment. Utilization review Nurses also verify that health care costs and policies are being properly followed. Responsibilities shown on sample resumes of Utilization review Nurses include referring cases to medical directors where appropriate, and requesting additional information to perform thorough medical necessity assessments. Utilization review Nurses' resumes reflect a bachelor's degree in nursing, as well as registered nurse licensure and post-baccalaureate certificates in the fields of health care risk management or case management.
Looking for job listings? Utilization review Nurse jobs page. 1, utilization review Nurse, determined appropriateness and medical necessity of hospitalization and requested treatment (s) based on plan's guidelines, policies, milliman, and medical director review, if needed. Also, includes observation status. Responsible for requesting clinical information for concurrent review with strict adherence to uraq guidelines. Responsible for presenting, preparing, and submitting all recommendations for denial to the medical director and plan liaison, including arranging any peer-to-peer reviews, if requested by hospitalist, attending, or primary care physician.
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Ensures sterility of the instruments and machines used for the patient. Maintains cleanliness and orderliness within the clinic. Maintains sterility throughout the procedure, taking and developing dental x-rays Assists doctor during dental treatments, procedures and surgery Ensures comfort for the clients Candidate Info 7 head Dental Nurse/head Receptionist Assisting dentist in all aspects of dentistry Assisting with hiring and training staff Supervised. Candidate Info 9 roles Dental Nurse/receptionist Cleaned and assisted patients with denture and braces care sectional set up of dental surgical room Examined critically x-rays of the mouth of patients Assisted in the removal of decayed teeth Educated patients on how to brush and floss their. Booked appointments of patients Welcomed patients and searched for their files prior to treatment. Received payments and archived receipts for service. Candidate Info Free professional Resume Critique we have partnered with TopResume to bring you a free resume critique service. Upload your resume and within 48 hours TopResume will email you a detailed analysis of what hiring managers and automated systems think of your resume and how to improve. Your resume has revelation been submitted successfully!
Prepared patient specific notes and charts for immediate dentist follow-up. Participated in various routine procedures alongside dentist. Candidate Info 5, dental Nurse, responsible for all chair side nursing duties during all dental procedures such as fillings, root treatments, crown preparations, cleanings and dental check ups, occasionally implants and sinus lifts. Maintaining organized stock within the surgery, ordering necessary supplies, keeping the surgery tidy and clean. Making sure the decontamination room is meeting all sterilization requirements and doing my part as a team member to keep it running efficiently. Reviewing patient records essay to maintain up to date medical history's, radiographs, hygiene and check up appointments. Candidate Info 6, dental Nurse/assistant, provides information sought by clients and assists them with their needs. Provides all the necessary instruments and materials needed by the dentist for a particular dental procedure for a patient.
creating and delivering training seminars in accordance with organisation polocies and standards. Carrying out comprehensive peer reviews and clincal audit assessments and reviews. Part of a 2 Man Project team to plan and deliver Out of Area clinical Assistance, set up of apod basra (op telic) in August 2005 and planning for Afghanistan in 2006 (op herrick). Candidate Info 3, dental Nurse Assistant, admitted patient, conducted pre-operational and post operational care. Prepared instruments, assisted in procedures such as tooth extraction, dental prophylaxis, taking impression, fixing of dentures, root canal, tooth x-ray and film developing. Scheduled patient appointments, candidate Info 4, dental Nurse/receptionist, provided chair side support to the dentist. Worked on x-ray preparation and development.
Looking for cover letter ideas? Dental Nurse cover Letter. 1, dental Nurse, assisted periodontal surgery/graphing/biopsies and general hygiene. Educated patients on oral/dental hygiene, projected office interests. Performed general office ensured smooth operation. Product sales training during patient visits, increase office profit. Candidate type Info 2, senior Dental Nurse/deputy Practice manager, responsible for completing General Dental Nurse duties in addition to managing the practice on behalf of the raf.
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Dental Nurses assist dentists and help providing oral healthcare services to patients. Based on our plan most successful sample resumes, typical Dental Nurse duties are greeting patients, preparing them for procedures, offering oral care advice, sterilizing equipment and instruments, and helping the dentist when required. They may also need to handle several administrative tasks like updating records. A well-written example resume should mention assets like nursing expertise, empathy, communication, interpersonal skills and teamwork. Education requirements include dental assistant certification and in some cases, state licensure. For more information on what it takes to be a dental Nurse, check out our complete. Dental Nurse job Description.