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Online Resumes with "Interqual"
Case Manager - 20 Years of Experience - Near 33012
Tags for this Online Resume: EQ SUITES, INTERQUAL, ICD10, ECIN, Bilingual, Computer Aided Software Engineering, Computer Literate, Health Insurance Portability And Accountability Act, Home Health, Medicare, Therapy
Medical or Health Services Manager - 20 Years of Experience - Near 33534
SUMMARY * 15+ years' experience as a clinical professional with a broad range of healthcare experience, talent and expertise also in Medicaid claims reviews programs * Extensive nursing experience in multiple areas (Utilization Review/Managed Care including Inpatient/Outpatient service for Pre-Cert, Concurrent Review, Case Management, Medical Claim/Bill Review, ICD-9/ICD-10 Coding, Hedis Reviews, Home Health Care, School Nu...
Tags for this Online Resume: Medicare, Computer Aided Software Engineering, Management, Injections, Insurance, VITAL SIGNS, Medication Administration, Nursing, Wound Care, D.O.D., Case Manager, Billing, Coding, Auditing, Utilization Review, Manager, Supervisor, Health Services, Nurse, LPN, Trainer
Licensed Nurse - 20 Years of Experience - Near 33610
Healthintegrated - April 18 2016 to May 19 2017 Utilization Review Coordinator Telephonic pre-authorization of procedures over the phone for inpatient and outpatient utilizes clinical skills to support the coordination documentation and communication of medical services and/or benefit administration determinations. Critical competencies include flexibility professionalism as well as clinical knowledge with claims. InterQual...
Tags for this Online Resume: Back Office, LPN, Drug Screen, Home Health, Injections, Management, Nursing, Patient Care, Patient Education, Policies and Procedures
Registered Nurse - 20 Years of Experience - Near 21076
an opportunity to utilize my knowledge & skills as a Utilization Review Specialist remotely. EMPOLYMENT HISTORY Utilization Review Manager VA Hospital Baltimore, MD 2013 to present My current position as a Utilization Review Management is a fulltime position and I work as an autonomist nurse from home. I am a member of an interdisciplinary team for the Critical Care Service Line. The team consists of a Case Manager, Social ...
Tags for this Online Resume: Cardiovascular, Medical, Medical/Surgical, Neurological, Nursing, Surgical, Telemetry, physical therapist, outpatient physical therapy, outpatient rehabilitation, physical therapy, pt, medical
Case Manager - 19 Years of Experience - Near 07110
SUMMARY OF QUALIFICATIONS: Nursing professional with diversified clinical and leadership background in case management, utilization review and discharge planning independent consultant as a Health and Wellness Advisor. * Experience with acute / critical care settings, insurance companies, skilled nursing and assisted living facilities. * Proven record in obtaining high quality outcomes, reduction in length of stay and cost-...
Tags for this Online Resume: Management, Referrals, CCU, registered nurse, healthcare
Case Manager - 20 Years of Experience - Near 92630
I am looking for a full time permanent opportunity with a growing Case Management Company with excellent comprehensive benefits including Health Insurance, dental, vision and 401k option. I am a dedicated, highly skilled, self-motivated, registered nurses that that has significant experience with workers compensation & commercial case management as well as Utilization Management. I am also highly skilled in using Microsoft...
Ideal Companies: Strong and Stable, Kaiser, Hoag, St Joseph.
Tags for this Online Resume: healthcare, rn, case manager, utilization review, Registered Nurse, Milliman Care Guidelines, care coordination
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
Medical or Health Services Manager
Areas of Expertise * Acute Care Facility & Ambulatory Care Experience * Radiation Oncology & Medical Oncology * Utilization Management-Inpatient & Outpatient Review * Transplantation & Genetic/Molecular Marker Testing * Clinical Research via National Clinical Trials * McKesson, Interqual, NCCN, ASCO, & CMS National Guidelines FDA Approval * Guidelines and policies written and maintained * Multi-tasking in fast-paced environ...
Tags for this Online Resume: Oncology, Radiation, Acute Care, Ambulatory Services, ARIA, Biopsy, Brachytherapy, Chemotherapy, Clinical Research, Cms
Case Manager
Summary Director of Nursing in Long-Term Care I have been a Director of Nursing for nursing homes in the state of Texas for over15 years. During that time I have opened up # 1 nursing facility, directed that facility to a 4 Star rated facility, and maintained a good reputation with the Texas Department of Health and Human Services in Arlington, Texas. Medical-Surgical Nursing During my nursing practice I have worked the Acu...
Tags for this Online Resume: Patient Care, Cancer, Computer Aided Software Engineering, Insurance, Psychiatry, Rehabilitation, Nursing, Quality Assurance, Test, Acute Care
Registered Nurse - 20 Years of Experience
Professional Summary: Donna Lowe, RN CCM brings 20+ years of clinical experience with 11 years in direct Case Management in an acute care setting. She has 10 years experience with Discharge Planning and Complex Care Management with a successful record of decreasing the overall acute care length of stay. Donna has substantial experience in coordination of resources across the hospital from the ICU, ER, Neuro, Cardiac, Ortho,...
Tags for this Online Resume: Case Manager, Certified RN Case Manager, Detailed Medical Record Review, registered nurse, CCM, Workers Compensation, Local travel, Legal, Medicare, Patient Care
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
