RN-Case Manager

Acute Hospital,Admission Criteria,Care coordination,Discharge Planning,Utilize InterQual Criteria,Utilize Milliman Guidelines,Concurrent Review,Continued Stay Reviews,Determine Medical Necessity per Evidence-Based Guidelines,Needs Assessment/ Order DME,Plan of Care,Concurrent Review,Continued Stay Reviews,Quality Improvement,Utilize InterQual Criteria,Utilize Milliman Guidelines,CMS: Centers for Medicare and Medicaid Services,HIPAA guidelines (Health Insurance Portability and Accountability Act),The Joint Commission/ Core Measure/National Safety GoalsEmergency Department,ICU,MS,SDU/PCU/IMC/Obs,Women’s Services,Appeals and Denials,Benefits Eligibility,Admission Criteria,Appeals and Denials,Pre-Cert Review,Prior Authorization,Department of Health,DRG (Diagnosis Related Groups),NCQA (National Committee for Quality Assurance),OSHA