Medical Utilization Review Coordinator - The Comprehensive Guide

Medical Utilization Review Coordinator - The Comprehensive Guide
Author: VIRUTI SHIVAN
Publisher: Viruti Satyan Shivan
Total Pages: 233
Release:
Genre: Medical
ISBN:

In the rapidly evolving landscape of healthcare, the role of a Medical Utilization Review Coordinator has never been more critical. This comprehensive guide is designed to navigate you through the complexities of healthcare management, ensuring efficiency, compliance, and optimal patient care. Whether you're new to the field or looking to enhance your expertise, this book offers a treasure trove of insights, strategies, and best practices. By focusing on the intersection of medical necessity, patient rights, and regulatory requirements, it prepares you to become an invaluable asset to any healthcare organization. Without relying on images or illustrations, this guide delves deep into the core responsibilities of a Medical Utilization Review Coordinator, from conducting thorough patient case reviews to navigating insurance verifications and appeals. It emphasizes the importance of evidence-based decisions, interdisciplinary collaboration, and ethical patient advocacy. This book stands out by offering real-world scenarios, expert advice, and actionable tips to excel in this demanding yet rewarding career. As the healthcare industry continues to face unprecedented challenges, equip yourself with the knowledge and skills to make a significant impact on the quality and efficiency of care provided.

The Hospital Guide to Contemporary Utilization Review

The Hospital Guide to Contemporary Utilization Review
Author: Stefani Daniels
Publisher:
Total Pages: 0
Release: 2015-04-16
Genre: Hospital utilization
ISBN: 9781556452147

The Hospital Guide to Contemporary Utilization Review is a comprehensive resource designed to identify utilization review (UR) best practices and provide guidance on developing and enhancing a contemporary UR committee. This book focuses on the latest UR and patient status requirements to help hospitals perform high-quality reviews and comply with regulations. The book covers a range of topics, including compliance with the UR Condition of Participation, legal obligations of a hospital, contract language, and compliant UR plan language to provide an understanding of the expectations of a UR program. Tips for intradepartmental collaboration are included to guide professionals through the process of selecting a physician advisor and partnering with nurses, case managers, and revenue cycle team members. This book will help you do the following: Identify the components of a best practice hospital utilization review (UR) program Describe the legal obligations of the hospital to comply with chapter 42 CFR 482.30 of the Conditions of Participation (CoP) Use the publication as a tool to assess his or her own hospital's UR processes Summarize the benefits of a dedicated UR team to promote compliance with the CoP Facilitate the development of a contemporary UR committee Assess an organization's opportunities to improve processes to benefit patient care and hospital success Recommend compliant language for the organization's UR plan Construct commercial contract language, in collaboration with the organization's contract manager, that promotes a partnership to ensure appropriate use of acute care resources Seek out operational resources to perform high-quality reviews that fully comply with the CoP Explain the connection between a good utilization review plan and the hospital revenue cycle initiatives

A Guide for Nurse Case Managers

A Guide for Nurse Case Managers
Author: Charlotte Cox
Publisher: iUniverse
Total Pages: 93
Release: 2010-08-12
Genre: Medical
ISBN: 1450238564

The position of nurse case managers can be a rewarding but challenging career, as these managers play a vital role in a patient’s care. In A Guide for Nurse Case Managers, author Charlotte Cox provides an insightful guide to this evolving field of medicine. Geared for those working in hospital settings, clinics, and health plan offices, this helpful reference text provides guidelines, tips, and tools for becoming a successful nurse case manager. With more than thirty years of health care experience, Cox provides a detailed overview of this important nursing position that works to usher a patient through the health care system. A Guide for Nurse Case Managers • defines the case manager role; • provides an understanding of the basics of utilization and case management; • gives an overview of Medicare and Medicaid procedures; • discusses the care planning process; • shows how to structure a community resource base. Whether you are a new case manager, a student, or a seasoned nurse needing a refresher about job basics, A Guide for Nurse Case Managers will help to shape your practice, provide valuable tips and reference tools, and help you with proven organizational ideas to succeed in the career.

Current Catalog

Current Catalog
Author: National Library of Medicine (U.S.)
Publisher:
Total Pages: 1430
Release:
Genre: Medicine
ISBN:

First multi-year cumulation covers six years: 1965-70.

A Case Manager's Study Guide

A Case Manager's Study Guide
Author: Denise Fattorusso
Publisher: Jones & Bartlett Learning
Total Pages: 374
Release: 2003
Genre: Business & Economics
ISBN: 9780763725044

A Case Manager's Study Guide: Preparing for Certification is the most comprehensive, print & electronic combination study guide for case management certification available on the market. It is designed specifically for study for the largest & most well-respected exam - the Certified Case Manager Exam (CCM). This study guide is organized to help you focus on the areas recommended for study by the certification board. The pre-test in the study guide helps you assess what areas of the text you should focus on most. More than 600 questions throughout the study guide are written in the formats favored by the CCM. Interactive CD-ROM software makes it easier, faster & more fun to study & learn. The software automatically scores your practice tests overall & by subject areas so you can assess your strengths & weaknesses; allows you to simulate the real test by taking timed tests; instantly provides the answers & explanatory text to the questions you missed; allows you to take as many practice exams as you want, with questions selected randomly by the software.