Reviewing and analyzing medical records in personal injury casesTranslating intricate medical terminologies into language comprehensible for attorneysManaging the record retrieval process, ensuring that every detail is in its rightful placeTaking the lead when a case becomes "deposition ready" from a record standpointCreating clear and concise chronologies from medical, employment, and other records, equipping ourattorneys with the tools they needSpearheading the… Show more Reviewing and analyzing medical records in personal injury casesTranslating intricate medical terminologies into language comprehensible for attorneysManaging the record retrieval process, ensuring that every detail is in its rightful placeTaking the lead when a case becomes "deposition ready" from a record standpointCreating clear and concise chronologies from medical, employment, and other records, equipping ourattorneys with the tools they needSpearheading the identification and collaboration with potential medical expert Show less

• Review home health prior authorization requests for home health services using clinical judgement.• Review home health appeals to ensure initial authorization was processed accordingly and conductan appeal review for authorization with additional information stakeholder provides while ensuring turnaround time is met.• Provide education on prior authorization request and medical management processes.• Review for appropriate care in the appropriate setting by following state… Show more • Review home health prior authorization requests for home health services using clinical judgement.• Review home health appeals to ensure initial authorization was processed accordingly and conductan appeal review for authorization with additional information stakeholder provides while ensuring turnaround time is met.• Provide education on prior authorization request and medical management processes.• Review for appropriate care in the appropriate setting by following state guidelines, Medicareguidelines, and Humana policies. Closely monitor guidelines for updates that may impact the reviewprocess and apply changes accordingly.• Coordinate with stakeholders to obtain additional clinical information and also provide education.• Coordinate with medical director and internal stakeholders on complex clinical reviews.• Consult with team members and leadership to discuss and bring forth new ideas on internal work Show less

Responsible for the coordination of the Resident Assessment Instrument (RAI) process to ensureaccurate and timely completion of resident assessments in accordance with Medicare, Medicaid, OBRAand other payer program requirements. Ensures assessments accurately reflect the physical, mentaland psychosocial status of each resident; ensures appropriate documentation to report and supportservices provided and assessment accuracy. Communicates effectively with other members of… Show more Responsible for the coordination of the Resident Assessment Instrument (RAI) process to ensureaccurate and timely completion of resident assessments in accordance with Medicare, Medicaid, OBRAand other payer program requirements. Ensures assessments accurately reflect the physical, mentaland psychosocial status of each resident; ensures appropriate documentation to report and supportservices provided and assessment accuracy. Communicates effectively with other members of theinterdisciplinary team.Follows all RIHS policies and procedures.Essential Functions• Ensures timely, accurate, and complete assessment of the resident’s health and functional status duringthe entire assessment period.• Participates in the pre-admission process to ensure essential information needed for MDS/Case Mixoptimization is obtained from the referral source(s).• Ensures accurate and timely completion of all Medicare/Medicaid case-mix documents to assureappropriate reimbursement for services provided within the facility.• Works in collaboration with the facility Director of Rehab to ensure the most appropriate assessmentreference date (ARD) is utilized for Medicare/Managed Care Assessments.• Tracks Skilled (MRA/MCO/MCG/MMP) customers utilizing Case Management Tools to determinecontinued and appropriate Medicare/Managed Care eligibility and benefit period through regularcommunications with Regional Care Management Specialist, Business Office and external CaseManagers.• Gathers information needed for Managed Care Utilization Reviews throughout the resident’s stay andcommunicates this with the Managed Care organization’s Case Manager as required.• Ensures that additional requirements of the Medicare Program are met, such as Physician certificationand re-certification.• Performs concurrent MDS review to assure appropriate RUGs category is achieved through the captureof appropriate clinical rectifies if appropriate. Show less

Manage and perform surgery scheduling for assigned physician.Obtained prior authorization for surgical procedures.Provided patient education for pre&post procedure instructions.Assist surgeon with bedside minor surgery procedures.•Schedules all surgical procedures as needed, coordinating with CT VS physicians, all area operatingrooms, other hospital departments involved, perfusionists, industry vendors and physicians outside ofthe CT VS practice•Coordinates… Show more Manage and perform surgery scheduling for assigned physician.Obtained prior authorization for surgical procedures.Provided patient education for pre&post procedure instructions.Assist surgeon with bedside minor surgery procedures.•Schedules all surgical procedures as needed, coordinating with CT VS physicians, all area operatingrooms, other hospital departments involved, perfusionists, industry vendors and physicians outside ofthe CT VS practice•Coordinates daily surgery assignments for physician assistants, nurse practitioners and surgical scrubtechnicians•Maintain communication with all area operating room schedulers to facilitate the progression of the CTVS surgery schedule in the most efficient manner•Coordinate physician operating room schedules with their clinic and administrative schedules•Serves as liaison between CT VS and all area hospital operating rooms Show less

Oversee the infrastructure that coordinates necessary resources for members who are in need ofauthorizations of DME, adaptive aids, minor home modifications, respite, emergency response system,personal care attendant, habilitation, specialized skill nursing, and DAHS.Coordinate and communicate with(State representatives, CSHCN program) on processing issues, policyupdates (State representatives, Program leaders, Claims, Training, Quality Assurance, Compliance,Publications… Show more Oversee the infrastructure that coordinates necessary resources for members who are in need ofauthorizations of DME, adaptive aids, minor home modifications, respite, emergency response system,personal care attendant, habilitation, specialized skill nursing, and DAHS.Coordinate and communicate with(State representatives, CSHCN program) on processing issues, policyupdates (State representatives, Program leaders, Claims, Training, Quality Assurance, Compliance,Publications, Data Management Operations, Appeals, Medical Directors) to develop, enhance andimplement appropriate policies, work processes, and procedures. Partner with internal staff to reviewand process complaints for members and providers. Provided education to providers and internal staff ofpolicy updates and procedures to aide in successful authorization request or appeal. Monitor individualteam member performance closely and provided re-education or created performance plan to helpensure individual made progress on required production and quality goals. Review analyses of activities,costs, operations and forecast data to determine progress toward stated goals and objectives.Compile and review multiple reports on work function activities for statistical purposes, financial trackingpurposes and for process improvement to identify trends, assist in financial forecasting, and makerecommendations to management. Monitor and report on achievement of committed action plans. Madeoverall time assignment and coordinated with team leaders and managers to ensure all barriers areremoved to ensure productivity and quality goals are met. Quality audit checks and education. Risk management review and analysis. Collaborate with IT on productivity improvement with Tableau. Show less