Case Manager
San Angelo, TX · On-site
$19.50 - $25.25/hr
Performs Utilization Review accurately and refers cases appropriately for secondary review ... the chart and documents. * Provides adequate communication of relevant issues to the ...
Case Manager
San Angelo, TX · On-site
$19.50 - $25.25/hr
Performs Utilization Review accurately and refers cases appropriately for secondary review ... the chart and documents. * Provides adequate communication of relevant issues to the ...
Case Manager
$19.50 - $25.25/hr
Performs Utilization Review accurately and refers cases appropriately for secondary review ... the chart and documents. * Provides adequate communication of relevant issues to the ...
Case Manager
$19.50 - $25.25/hr
Performs Utilization Review accurately and refers cases appropriately for secondary review ... the chart and documents. * Provides adequate communication of relevant issues to the ...
Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and ...
Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and ...
Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and ...
Responsibilities MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return ...
Responsibilities MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return ...
Responsibilities MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return ...
Responsibilities MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and ...
Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and ...
Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and ...
Responsibilities MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return ...
Responsibilities MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
Participates in medical chart peer review, case record review and utilization review as deemed necessary. * Assumes responsibility for therapeutic equipment safety, operation and maintenance.
Participates in medical chart peer review, case record review and utilization review as deemed necessary. * Assumes responsibility for therapeutic equipment safety, operation and maintenance.
Occupational Therapist - Physical Therapy
Texarkana, TX · On-site
$37.25 - $49.25/hr
Participates in medical chart peer review, case record review and utilization review as deemed necessary. * Assumes responsibility for therapeutic equipment safety, operation and maintenance.
Occupational Therapist - Physical Therapy
Texarkana, TX · On-site
$37.25 - $49.25/hr
Participates in medical chart peer review, case record review and utilization review as deemed necessary. * Assumes responsibility for therapeutic equipment safety, operation and maintenance.
Occupational Therapist - Physical Therapy
Texarkana, TX · On-site
$36 - $47.50/hr
Participates in medical chart peer review, case record review and utilization review as deemed necessary. * Assumes responsibility for therapeutic equipment safety, operation and maintenance.
Occupational Therapist - Physical Therapy
Texarkana, TX · On-site
$36 - $47.50/hr
Participates in medical chart peer review, case record review and utilization review as deemed necessary. * Assumes responsibility for therapeutic equipment safety, operation and maintenance.
Participates in medical chart peer review, case record review and utilization review as deemed necessary. * Assumes responsibility for therapeutic equipment safety, operation and maintenance.
Participates in medical chart peer review, case record review and utilization review as deemed necessary. * Assumes responsibility for therapeutic equipment safety, operation and maintenance.
Certified Occupational Therapist Assistant - Physical Therapy
Texarkana, TX · On-site
$26.50 - $35.25/hr
Participates in medical chart peer review, case record review and utilization review as deemed necessary. * Assumes responsibility for therapeutic equipment safety, operation and maintenance.
Certified Occupational Therapist Assistant - Physical Therapy
Texarkana, TX · On-site
$26.50 - $35.25/hr
Participates in medical chart peer review, case record review and utilization review as deemed necessary. * Assumes responsibility for therapeutic equipment safety, operation and maintenance.
Chart Utilization Review information
What are the key skills and qualifications needed to thrive as a chart utilization review specialist, and why are they important?
To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.
What is chart utilization review?
Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.
What are some common challenges faced by professionals in chart utilization review, and how can they be addressed?
Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.
What is the difference between Chart Utilization Review vs Chart Review Specialist?
| Aspect | Chart Utilization Review | Chart Review Specialist |
|---|---|---|
| Credentials | Typically requires healthcare or insurance-related certifications | Often requires medical or coding certifications |
| Work Environment | Healthcare facilities, insurance companies, utilization management teams | Medical offices, insurance companies, coding firms |
| Employer & Industry | Hospitals, insurance providers, healthcare organizations | Medical billing companies, insurance firms, healthcare providers |
| Primary Focus | Assessing medical necessity and appropriateness of services | Reviewing medical records for coding accuracy and completeness |
While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.
What are popular job titles related to Chart Utilization Review jobs in Texas? For Chart Utilization Review jobs in Texas, the most frequently searched job titles are:
- Flexible Cvs Utilization Management Nurse
- Part Time Utilization Review Nurse
- Remote Per Diem Utilization Review Nurse
- Evening Utilization Review Nurse
- Per Diem Utilization Review Nurse
- Weekend Physician Advisor Utilization Review
- Remote Utilization Management Nurse
- Remote Medical Review Nurse
- Manager Utilization Management
- Overnight Utilization Review Nurse
What job categories do people searching Chart Utilization Review jobs in Texas look for? The top searched job categories for Chart Utilization Review jobs in Texas are:
- Medical Claims Review Nurse
- Utilization Review Case Manager
- Online Utilization Review
- Insurance Utilization Review
- Utilization Review Nurse Compact License
- Night Shift Optum Utilization Review
- Remote Occupational Therapy Utilization Review
- Weekend Utilization Review
- Remote Hca Utilization Review
- Overnight Remote Utilization Review
What cities in Texas are hiring for Chart Utilization Review jobs? Cities in Texas with the most Chart Utilization Review job openings:
Job description
Job Summary
The Registered Nurse (RN) is responsible for facilitating the patient's hospitalization from preadmission through discharge. The RN coordinates with physicians, nurses, social workers, and other health team members to expedite medically appropriate cost-effective care. The RN advises the health care team and provides leadership as needed.
Performance: Position Specific Essential Functions
Qualifications
Education
Experience:
Certification/Licensure:
The Registered Nurse (RN) is responsible for facilitating the patient's hospitalization from preadmission through discharge. The RN coordinates with physicians, nurses, social workers, and other health team members to expedite medically appropriate cost-effective care. The RN advises the health care team and provides leadership as needed.
Performance: Position Specific Essential Functions
- Proactively assesses patients and establishes Discharge Care (DC) Plan. consults with and keeps unit/Interdisciplinary Team informed of DC plan. Documentation is completed in a timely manner.
- Performs Utilization Review accurately and refers cases appropriately for secondary review. Performs initial utilization review and continued stay reviews. Ensures status orders are in place and keeps insurance company informed for certification of days. Documentation is completed in a timely manner.
- Assesses the patient by collecting information about the patient's home situation and health care needs through direct client contact and other relevant sources to include family, caregivers, etc.
- Utilizes established criteria to determine appropriateness of Inpatient admission/status to ensure the appropriate level of care and assists staff with interpretation of the criteria, as indicated.
- Attends department meetings and participates in unit activities to stay informed.
- Provides "Choice Letter" and assists the patient with selecting a DME company, Nursing Home, Assisted Living facility, Home Health agency, Hospice, etc.; obtains signature on the choice Letter by the patient/family and ensures placement in the chart and documents.
- Provides adequate communication of relevant issues to the interdisciplinary healthcare team and initiates referrals to service providers as identified in the discharge plan. Coordinates discharge teaching.
- Ensures that the interdisciplinary care/discharge plan is consistent with the patient's clinical course, continuing care needs and covered services and modifies, as indicated.
- Reports and discuss with attending physicians and or physician advisors the appropriateness of resource utilization, consultations, and treatment plan.
- Assists with establishing Advance Directives, Medical power of Attorney, etc. as indicated. Identifies and establishes legal guardian/decision maker.
- Utilizes the Patient/Visitor Safety Learning Report to document patient safety issues and complaints related to care.
- Encourages patients to actively participate in meeting short and long-term healthcare goals and identifies appropriate community resources and support services to assist the patient.
- Tracks and ensures that the Important Message from Medicare has been provided to the Medicare patient on admission and that a follow-up copy has been provided, initialed and placed in the chart.
- Reviews the patient's progress as described by the various disciplines involved on an ongoing basis to ensure an effective plan is in place.
- Ensures discharge prescriptions, orders, and appointments are made, DME, OP services, Nursing Home care, etc. have been arranged and discharge, transfer, and referral forms are as complete as possible prior to patient departure.
- Develops a discharge/care management plan in collaboration with other members of the healthcare team, the physician and 3rd party payers, as indicated.
- Communicates the plan with the patient and family/significant other and adjusts the plan based on the patient's progress, input, and needs.
- Performs other duties as assigned.
Qualifications
Education
- Required
- High School Diploma, GED, or equivalent
- Associate's degree in Nursing
- Preferred
- Bachelor's degree in Nursing
Experience:
- Required
- 3-5 years Clinical Experience as a Registered Nurse in a Healthcare/Medical setting
- Preferred
- 2-3 years in a Supervisor Role
Certification/Licensure:
- Required
- Registered Nurse (RN), with authorization to practice in the State of Texas
- Basic Life Support (BLS) Certification
- Must obtain within ninety (90) days of start date
- Preferred
- Relevant national certification
About Shannon Health
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