Accomplishments
- Acute Care Facility Onsite Assessment
- RAC Readiness & Response
- Focusing on and anticipating Recovery Audit Contractor (RAC) target areas
- Assessment of areas of Case Management impacting
- Admissions
- Length of Stay
- Discharge Planning
- Utilization Review
- Documentation in Medical Record
- Staff Education
- Appeals of RAC Denials
- Team Designation
- Case Management Effectiveness
- Policy and Procedure, Department Manuals Review
- Adherence to Medicare and State Regulations
- Documentation of Medical Necessity
- Notification to Patients and Family
- Staffing and Staff Qualifications
- Interface with Physicians, Nursing, Other Professionals,
- Interface with Admissions, Coding, Medical Records, Finance
- Medical Record Documentation
- External Resources
- Unit Specific Case Rounding
- Appeals Strategy
- Independent Medical Review Coordination
- URAC Accreditation
- Process Federal, State, and International Reviews
- Standard, Expedited Reviews
- Large Peer Review Panel, all Specialties
- Graduate-UCSF, School of Nursing
- Bachelor of Science in Nursing
- Registered Nurse, Licensed in California
- Public Health Nursing Certificate
- School Nursing Certificate
Education
