finial project
Maintain ongoing tracking and appropriate documentation on referral tracking.
a. Communicates with clinical staff any issues or any need of further follow up.
b. Contacts the patient regarding any pending referrals, and or diagnostic testing.
Telephones providers of specialty services to set up appointments
Demonstrated ability to maintain referral documents and contacting insurance companies to ensure all approvals are met
Receive and process referrals based on standard procedures and policies of the healthcare service
Ensures patients have been cleared for specialty service office visits. Resolves pre-certification, registration and case-related concerns prior to a patient's appointment. Gathers pertinent information from insurance carriers, financial counselors, and other ancillary staff to make certain the patient is not financially obligated for services provided. Requires an associate's degree or its equivalent and 2-4 years of experience in the field or in a related area. Has knowledge of commonly-used concepts, practices, and procedures within a particular field. Relies on instructions and pre-established guidelines to perform the functions of the job. Works under immediate supervision. Typically reports to a supervisor or manager.
Utilization management is the evaluation of the appropriateness, medical need and efficiency of health care services procedures and facilities according to established criteria or guidelines and under the provisions of an applicable health benefits plan. Typically it includes new activities or decisions based upon the analysis of a case.
Utilization management describes proactive procedures, including discharge planning, concurrent planning, pre-certification and clinical case appeals. It also covers proactive processes, such as concurrent clinical reviews and peer reviews, as well as appeals introduced by the provider, payer or patient.
As pre-certification and concurrent review of cases
a. Communicates with clinical staff any issues or any need of further follow up.
b. Contacts the patient regarding any pending referrals, and or diagnostic testing.
Telephones providers of specialty services to set up appointments
Demonstrated ability to maintain referral documents and contacting insurance companies to ensure all approvals are met
Receive and process referrals based on standard procedures and policies of the healthcare service
Ensures patients have been cleared for specialty service office visits. Resolves pre-certification, registration and case-related concerns prior to a patient's appointment. Gathers pertinent information from insurance carriers, financial counselors, and other ancillary staff to make certain the patient is not financially obligated for services provided. Requires an associate's degree or its equivalent and 2-4 years of experience in the field or in a related area. Has knowledge of commonly-used concepts, practices, and procedures within a particular field. Relies on instructions and pre-established guidelines to perform the functions of the job. Works under immediate supervision. Typically reports to a supervisor or manager.
Utilization management is the evaluation of the appropriateness, medical need and efficiency of health care services procedures and facilities according to established criteria or guidelines and under the provisions of an applicable health benefits plan. Typically it includes new activities or decisions based upon the analysis of a case.
Utilization management describes proactive procedures, including discharge planning, concurrent planning, pre-certification and clinical case appeals. It also covers proactive processes, such as concurrent clinical reviews and peer reviews, as well as appeals introduced by the provider, payer or patient.
As pre-certification and concurrent review of cases