Medical Utilization Review Coordinator The Comprehensive Guide

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.

Mastering the Art of Healthcare Management and Policy Compliance 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.

A Case Manager's Study Guide: Preparing for Certification, Fourth Edition is the perfect study guide for new case managers preparing to take the Certified Case Manager (CCM) exam and practicing case managers who are recertifying. Based on the Commission for Case Manager Certification (CCMC) six knowledge domains and eight essential activities, it addresses new changes passed and legislative updates resulting in significant changes in healthcare and case management. New topics include patient-centered care, readiness to change, evidence-based case management, and management outcomes. Completely updated and revised, A Case Manager's Study Guide: Preparing for Certification, Fourth Edition contains nearly 700 questions and comprehensive answer rationales.Included with the book is an online Access Code for Navigate TestPrep, a dynamic and fully hosted online assessment tool designed to help nurses prepare for certification examinations by offering case-based questions, detailed rationales, and robust reporting. Navigate TestPrep: A Case Manager's Study Guide also sold separately.* Randomized questions create new exams on each attempt* Monitors results on practice examinations with score tracking and time on each task* Reporting tools evaluate progress and results on each attemptDon't forget to visit our nursing certification website: www.NursingCertificationSuccess.com.

Preceded by A case manager's study guide / Denise Fattorusso, Campion Quin. 4th ed. c2013.

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

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

Written by renowned author, Catherine Mullahy, The Case Manager’s Handbook, Fourth Edition, is the ultimate how-to guide for case managers. This practical resource helps case managers build fundamentals, study for the CCM exam, and most importantly, advance their careers after the exam. Using real-life examples and an easy-to-read, conversant style, this reference defines “Best in Class” case management, examines the case management process, and presents practical procedural information. It is an excellent daily reference and training resource for new case managers and seasoned professionals in various setting facing the day-to-day challenges of case management. Certain to become the “go to resource” resource that previous editions have, this Fourth Edition features updated and enhanced chapters, and brand new chapters covering such timely topics as: * Obesity – The New Epidemic * Our Nation’s Multiculturalism and Challenges to Case Managers * Health Literacy and Adherence Issues * Pharmaceuticals – The Ever-Evolving World * Our Aging Population, Medical Advancements and New Case Management Considerations * Direct to Consumer Community-Based Case Management * Continuum Concepts