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. Ensuring all patients receive “the right care, the right cost, right time, and in the right setting.”

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.

Demonstrates thorough knowledge in the application of InterQual medical necessity criteria:

Assess the safest and most efficient care level based on severity of illness, comorbidities and complications, and the intensity of services being deliveredUtilizes IQ Criteria to provide recommendation(s) to the attending physician Communicates payor criteria and issues on a case-by-case basis with multidisciplinary team and follows up to resolve problems with payors as needed; initiates peer to peer when appropriate

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. Ensuring all patients receive “the right care, the right cost, right time, and in the right setting.”

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.

Demonstrates thorough knowledge in the application of InterQual medical necessity criteria:

Assess the safest and most efficient care level based on severity of illness, comorbidities and complications, and the intensity of services being deliveredUtilizes IQ Criteria to provide recommendation(s) to the attending physician Communicates payor criteria and issues on a case-by-case basis with multidisciplinary team and follows up to resolve problems with payors as needed; initiates peer to peer when appropriate