Provide concurrent review and analysis of inpatient records to determine if the patient's admission and continued acute stay flags any quality indicators.
Coordinate chart reviews for quality reports and clinical procedures
Process TARS as needed
DRG and ICD-9 and CPT coding, requirements for prior approval.
Available community resources.
Effective charting practices and guidelines.
JCAHO Standards and Title XXII Regulations
Reimbursement related to Medicare, Medi-Cal & Managed Care
California Nursing License (RN)
2+ years of Experience
About the Agency: Managed Care Resources, Making Careers is a Health Care Staffing Agency in the niche fields of Case Management, Utilization Management / Review, Quality Management / Assurance and Performance Improvement. MCR, Making Careers has been servicing the State of California since 1987 providing Medical Professionals to Hospitals, Medical Groups, IPAs, Health Plans, Healthcare Foundations, Home Health Departments, Medical Offices, Managed Care and Insurance Companies in search of both Permanent and Temporary Staff. Call: (310)-470-4232 or (800)-350-1471 for more information!