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Online Resumes with "Inter Qual"
Registered Nurse - 20 Years of Experience - Near 95670
Career Summary: Over 20 years of experience in Acute Care and Health Service programs including Utilization Review, Provider Dispute Resolution, Quality Management, Inpatient and Ambulatory Case Management, and Grievance and Appeals in a managed care environment for both Health Plan and IPA/MSO settings using evidence based nationally recognized criteria such as ACOG, NCCN, MCG, InterQual and Health Plan Medical guidelines ...
Tags for this Online Resume: Compliance, Management, Quality Management, Assessments, Medical, Medicare, registered nurse, healthcare, Managed Care, Utilization Management
Case Manager - 6 Years of Experience - Near 10031
Accomplishments are: - Ongoing training in Inpatient Utilization Procedures to audit and review medical records - Conduct on-site/off site review of medical records for quality of care and utilization. - Review process including DRG validation and Interqual criteria approval. - Utilized review criteria with the use of InterQual, 3M coding book and grouper, SIMS Plus. - Increased knowledge base on medical comorbidities in ad...
Tags for this Online Resume: Infrastructure, Support, Technical Support, Services, Public Health, Reviews, Quality, Acquired Immune Deficiency Syndrome (AIDS), physical therapist
RN Case Manager Huntsville, AL
I am relocating to the Huntsville, AL area seeking an RN Case Manager position, Worker's Comp, or Utilization Review Nurse position.
Tags for this Online Resume: Case Management, Utilization Review, Worker's Comp, RAC audit, InterQual
Registered Nurse - 20 Years of Experience - Near 37040
SUMMARY OF QUALIFICATIONS Nurse with 40+ years' experience in training and coaching employees, peers, and superiors and quality assurance and medical record reviews experience resulting in outstanding results. * Active RN licensure in all compact and non-compact states * Experienced in medical record review, clinical data/chart review and quality improvement Experience with utilization review, review criteria development an...
Tags for this Online Resume: Reviews, Nursing, Managed Care, Phone Triage, Planning, Support, Long Term Care, LPN, Medicare, Ophthalmology
Case Manager - 21 Years of Experience - Near 19406
Baccalaureate-prepared Registered Nurse with extensive experience in case management and utilization review. Combining acute care experience, interpersonal communication skills and documentation expertise to optimize the care provided to patients. Skills/Areas of Expertise Case Management * Utilization Review * ICD-10 * InterQual Criteria * CMS Regulations * Electronic Medical Records
Tags for this Online Resume: Management, Computer Aided Software Engineering, Critical Care, Medical, Pulmonary, Surgical, Therapy, Acute Care, Nursing, Medical Records
Licensed Nurse - 31 Years of Experience - Near 60630
Registered Nurse * Effective Utilization Review and Case Management applications using InterQual, EQ Health, and Medi-Tech. * Highly skilled career professional with more than 30+ years practical experience in hospital, home health, and primary care environments. * Computer-skilled, managing heavy daily patient volume including telephone triage, appointment scheduling, and patient referral. Proficient in all documentation/...
Tags for this Online Resume: Medical, Medical/Surgical, Surgical, Test, Computer Aided Software Engineering, Management, Ophthalmology, Acute Care, Ambulatory Services, Applications
