The Impact You Can Make
Works in collaboration with the physician and interdisciplinary team to support the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing unnecessary and redundant care, and promoting clinical best practice..
Team Impact
The Glens Falls Hospital Impact
Mission
Our Mission is to improve the health of people in our region by providing access to exceptional, affordable, and patient-centered care every day and in every setting.
How You Will Fulfill Your Potential
Responsibilities
Conducts concurrent and retrospective review(s) utilizing InterQual (IQ) medical necessity criteria to monitor appropriateness of admissions and continued stays, and documents findings based on department standards; refers appropriate cases to EHR or Physician Advisor for recommendation(s)Ensures order in chart/EMR and status coincides with the InterQual review or CMS rules and regulations for appropriate Level of Care and status on all patients through collaboration with Care Manager.Assess the safest and most efficient care level based on severity of illness, comorbidities and complications, and the intensity of services being deliveredThe Impact You Can Make
Works in collaboration with the physician and interdisciplinary team to support the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing unnecessary and redundant care, and promoting clinical best practice..
Team Impact
The Glens Falls Hospital Impact
Mission
Our Mission is to improve the health of people in our region by providing access to exceptional, affordable, and patient-centered care every day and in every setting.
How You Will Fulfill Your Potential
Responsibilities
Conducts concurrent and retrospective review(s) utilizing InterQual (IQ) medical necessity criteria to monitor appropriateness of admissions and continued stays, and documents findings based on department standards; refers appropriate cases to EHR or Physician Advisor for recommendation(s)Ensures order in chart/EMR and status coincides with the InterQual review or CMS rules and regulations for appropriate Level of Care and status on all patients through collaboration with Care Manager.Assess the safest and most efficient care level based on severity of illness, comorbidities and complications, and the intensity of services being delivered