Legal nurse consultant vs utilization review nurse

Differences between legal nurse consultant and utilization review nurse duties and responsibilities

Legal nurse consultant example responsibilities.

• Manage all immunization and vaccination programs and ensure compliance to establish program guidelines.
• Maintain a professional working relationship with hospital staff, physicians, manage care organizations, Medicare and Medicaid providers.
• Perform pulmonary function, EKG and audiology testing.
• Examine cases involving fraud and abuse of government-fund agencies, including Medicare and Medicaid.
• Coordinate OSHA require medical surveillance.
• Perform and complete physical examinations in accordance to OSHA requirements.
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Utilization review nurse example responsibilities.

• Monitor patients' status during surgery (circulate in operating room) and manage patients in PACU.
• Case management for acute patients refer to LTC
• Advise insurance carriers on recommend reimbursement for charges following automate bill audit utilizing ICD-9 and CPT codes.
• Provide caregiver oversight relate to care, medication administration and emergency situations.
• Identify inappropriate utilization of services/settings through the application of establish clinical criteria using InterQual and CMS guidelines for medical necessity.
• Direct contact with IPA providers.
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