RN-Case Manager

Acute Hospital,MS,SDU/PCU/IMC/Obs,Admission Criteria,Benefits Eligibility,Care coordination,Concurrent Review,Continued Stay Reviews,Data Abstraction,Determine Medical Necessity per Evidence-Based Guidelines,Discharge Planning,Disease management,Needs Assessment/ Order DME,Plan of Care,Utilize InterQual Criteria,Utilize Milliman Guidelines,Admission Criteria,Concurrent Review,Continued Stay Reviews,Data Abstraction,Medical Necessity,Utilize InterQual Criteria,Utilize Milliman Guidelines,CMS: Centers for Medicare and Medicaid Services,DRG (Diagnosis Related Groups),HIPAA guidelines (Health Insurance Portability and Accountability Act)Ambulatory,Behavioral Health,Home Health,Hospice,Insurance Company,Long Term Acute Care/Rehab/Skilled Nursing,Telephonic,Behavioral Health,Emergency Department,ICU,NICU,Surgical Services,Women’s Services,Appeals and Denials,Audits,Disability case management,Pre-Cert Review,Prior Authorizations,Retrospective Review,Worker’s comp case management,Appeals and Denials,Audits,CPT (Current Procedural Terminology) coding and billing,Pre-Cert Review,Prior Authorization,Quality Improvement,Retrospective Review,CPT (Current Procedural Terminology) coding and billing,Department of Health,HEDIS (The Healthcare Effectiveness Data and Information Set) Measures,ICD 10 Coding,NCQA (National Committee for Quality Assurance),OSHA,The Joint Commission/ Core Measure/National Safety Goals,Workers Compensation