Utilization Review Nurse - Care Coordination & Cost Control

Personal Touch Home Health Care Services Inc.; Baldwin Park (CA); Presencial; USD 70.000 - 110.000; Tempo integral

Resumo da vaga

Personal Touch Home Health Care Services Inc. in Baldwin Park, CA is seeking a clinical reviewer to evaluate medical records and treatment plans for medical necessity and efficient utilization. The role ensures care aligns with established standards and promotes cost-effective decisions.

You will collaborate with physicians, caregivers, and care teams to coordinate coverage, support discharge planning, and promote compliant, high-quality health care delivery.

Qualificações

• Strong clinical judgment and ability to interpret medical records and treatment plans.

Responsabilidades

• Assess clinical documentation to support coverage decisions and ensure care aligns with established standards.
• Evaluate requested services for medical necessity, appropriateness, and cost-effective utilization.
• Collaborate with physicians, members, caregivers, and care teams to coordinate care and coverage.
• Support discharge planning and identify cost-of-care options that promote compliant, effective care.
• Coordinate referrals as needed to ensure continuity of care.
• Maintain a focus on compliant decision-making and efficient health care delivery.

Conhecimentos

Clinical judgment

Medical necessity knowledge

Collaboration & communication

Cost-conscious decision making

Descrição da vaga

Personal Touch Home Health Care Services Inc. in Baldwin Park, CA is seeking a clinical reviewer to evaluate medical records and treatment plans for medical necessity and efficient utilization. The role ensures care aligns with established standards and promotes cost-effective decisions.

You will collaborate with physicians, caregivers, and care teams to coordinate coverage, support discharge planning, and promote compliant, high-quality health care delivery.