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| interqual and milliman training: The Case Manager's Training Manual David W. Plocher, Patricia L. Metzger, 2001 Stem Cell and Bone Marrow Transplantation |
| interqual and milliman training: Commerce Business Daily , 2000-06 |
| interqual and milliman training: Core Skills for Hospital Case Managers Tony Cesta, Beverly Cunningham, 2009-06 Core Skills for Hospital Case Managers: A Training Toolkit for Effective Outcomes Toni Cesta, PhD, RN, FAAN; Beverly Cunningham, MS, RN As of June 20, 2014, contact hours for nurses are no longer available with this product. Finally--an affordable, effective, and consistent training program for your hospital case managers. This one-of-a-kind guide to fundamental case management responsibilities is a necessary reference tool for every hospital case management department. This resource is designed to give case management directors and hospital leaders the tools they need to build and strengthen the basic and advanced skills their case management staff needs to succeed. Core Skills for Hospital Case Managers is an orientation and training manual for nurses transitioning into case management, an easy-to-read reference guide for new case managers, and a source of inspiration, tools, and resources for seasoned professionals. With a flexible format, this book and CD-ROM offer practical information and customizable tools to develop and maintain a wide variety of care management skills. Table of contents Chapter 1: Hospital Case Management 101 Chapter 2: Case Manager Role Chapter 3: Roles, Functions, and Caseloads Chapter 4: The Case Management Process Chapter 5: The Case Manager's Role in Transitional and Discharge Planning Chapter 6: Utilization Management Chapter 7: Managing Long Length of Stay Patients Chapter 8: Denials: Prevention and Appeals Strategies Chapter 9: Reimbursement Chapter 10: The Role of the Case Manager in Patient Flow Chapter 11: Measuring Success: Strategic Outcome Measures Chapter 12: Dealing with the Uninsured and Underinsured Chapter 13: Working with Multidisciplinary Teams Chapter 14: Crucial Communication and Conflict Resolution Learning objectives: Discuss the evolution of hospital case management Explain the different models of hospital case management Determine the various goals of hospital case management Examine the various roles of case management Discuss the variety of functions performed by case managers Discuss the scope of the case manager position Examine staffing ratios in various models List the steps in the case management process Determine the role of case managers in documentation Examine case managers' role in discharge planning List the factors that influence the discharge planning process Determine strategies for improving discharge planning Discuss how hospital reimbursement affects utilization management (UM) List the stages of UM coordination Determine the affect of outside influences on UM Evaluate different payers' regulations regarding UM Examine case management's role in length of stay (LOS) Evaluate strategies for managing patients with long LOS Identify data used to track and trend LOS Evaluate the reasons behind denials Discuss case management's role in preventing denials Examine case management's roles in reversing denials Examine case management's role in reimbursement Determine strategies for effective case management related to reimbursement Evaluate case management's role in patient flow Discuss demand and capacity management Identify strategies for managing patient flow Identify measurable case management outcomes Explain how case managers can track quality outcome metrics Discuss other metrics case management departments can track and trend Examine ways to create a case management report card Discuss the unfunded or underfunded patient populations Describe the role of the ED case manager with unfunded or underfunded patient populations Evaluate strategies for dealing with unfunded or underfunded patient populations Examine strategies for successfully working with multidisciplinary teams Describe sources of conflict with which case managers frequently come in contact Discuss strategies for reducing conflict Intended audience Staff nurses, charge nurses, staff educators, staff development specialists, directors of education, nurse managers, and nurse leaders |
| interqual and milliman training: Along the Continuum of Care Pauline Sanders RN, 2013-05-23 Along the Continuum of Care creates a mind shift for the case manager in the new paradigm to be effective agents of change and resource connectors. The urgent need to improve health outcomes is resulting in moment-to-moment changes in the world of case management. Along the Continuum of Care focus on helping health care professionals meet the new challenges with Health Care Reform. Case Managers must educate the senior leadership team about the financial contributions that result from appropriate care coordination. The CEO is responsible for the bottom line but the buck stops with case management and leaders should focus on: *Case management support for adequate resources. *Ensuring that case management staff is educated, adequately staffed, and recognized for managing patient flow which maintains financial stability. *Recognizing that effective case managers manage the tipping point to save and/or create millions of dollars for the organization. The healthcare case management field is exploding. The demand will far outweigh the supply for the next three to five years and beyond. The business savvy case manager will lead the field. |
| interqual and milliman training: Case Management Suzanne K. Powell, 2000 The Second Edition of this comprehensive how to text has been completely revised and updated. This text outlines the basics of case management and illustrates some of the pitfalls encountered in the field of case management. The book provides information on the new Case Management Standards, supplies standard definitions and guidelines of case management for the practicing case manager, and presents information on caring for clients in a wide variety of health care settings. New to this edition--chapters focusing on Quality Reviews and Risk Management with a strong emphasis on Continuous Quality Improvement (CQI), ethical and legal issues, and various case studies. |
| interqual and milliman training: Healthcare Money Campfire Stories Eric Bricker, 2019-11 Learn 16 Ways Money Influences Healthcare and the Practice of Medicine That You Have Never Seen Before. 'Healthcare Money Campfire Stories' is based on the true experiences of Dr. Eric Bricker. Dr. Bricker is an internal medicine physician and former Co-Founder and Chief Medical Officer of Compass Professional Health Services. Compass is a Healthcare Navigation service that grew to 2,000+ clients including T-Mobile, Southwest Airlines and Chili's/Maggiano's Restaurants. Compass was acquired by Alight Solutions in July 2018. Alight is a 10,000 person employee benefits and HR outsourcing company that separated from Aon in 2017. In 'Healthcare Money Campfire Stories' you will learn 1) the physician hierarchy based on pay and lifestyle, 2) how hospitals spread financial risk just like insurance companies and 3) the key to a correct diagnosis and treatment plan--and lower cost healthcare. 'Healthcare Money Campfire Stories' teaches these three lessons along with 13 more through a series of stories that are short, suspenseful and sometimes funny... just like a campfire story. |
| interqual and milliman training: Improving the Quality of Health Care for Mental and Substance-Use Conditions Institute of Medicine, Board on Health Care Services, Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders, 2006-03-29 Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€use conditions will benefit from this guide to achieving better care. |
| interqual and milliman training: Denial Management Pam Waymack, 2005 |
| interqual and milliman training: Medical Quality Management Angelo P. Giardino, Lee Ann Riesenberg, Prathibha Varkey, 2020-08-31 This comprehensive medical textbook is a compendium of the latest information on healthcare quality. The text provides knowledge about the theory and practical applications for each of the core areas that comprise the field of medical quality management as well as insight and essential briefings on the impact of new healthcare technologies and innovations on medical quality and improvement. The third edition provides significant new content related to medical quality management and quality improvement, a user-friendly format, case studies, and updated learning objectives. This textbook also serves as source material for the American Board of Medical Quality in the development of its core curriculum and certification examinations. Each chapter is designed for a review of the essential background, precepts, and exemplary practices within the topical area: Basics of Quality Improvement Data Analytics for the Improvement of Healthcare Quality Utilization Management, Case Management, and Care Coordination Economics and Finance in Medical Quality Management External Quality Improvement — Accreditation, Certification, and Education The Interface Between Quality Improvement and Law Ethics and Quality Improvement With the new edition of Medical Quality Management: Theory and Practice, the American College of Medical Quality presents the experience and expertise of its contributors to provide the background necessary for healthcare professionals to assume the responsibilities of medical quality management in healthcare institutions, provide physicians in all medical specialties with a core body of knowledge related to medical quality management, and serve as a necessary guide for healthcare administrators and executives, academics, directors, medical and nursing students and residents, and physicians and other health practitioners. |
| interqual and milliman training: The Hospital Guide to Contemporary Utilization Review Stefani Daniels, Ronald L Hirsch, MD, Facp, Chcqm, Ronald L. Hirsch, 2015-04-16 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 |
| interqual and milliman training: 2022 CDI Pocket Guide Pinson & Tang LLC, 2021-10-15 |
| interqual and milliman training: The Asam Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions David Ed Mee-Lee, 2013 Pre-order today the new edition of the most widely used and comprehensive set of guidelines for placement, continued stay and transfer/discharge of patients with addiction disorders. The ASAM Criteria has been completely redesigned and updated to apply the newest science in the field of addiction medicine, is compliant with the DSM-5 and incorporates a user-friendly functionality. The ASAM criteria are the most intensively studied set of addiction placement criteria, having undergone numerous evaluations and studies of effectiveness. Research shows that treatment based on the ASAM criteria is associated with less morbidity, better client function and more efficient service utilization than mismatched treatment. The criteria are required in over 30 states and provide the addiction field with nomenclature for describing the continuum of addiction services. The ASAM Criteria is your resource in providing timely, appropriate, and effective care through a holistic and multidimensional approach that matches patient needs to specific treatment services. |
| interqual and milliman training: Understanding Pharmacy Reimbursement F. Randy Vogenberg, 2006 As a health system pharmacist dealing with health care reform initiatives and accountable care organizations, it is important to have a fundamental understanding of health care reimbursement that has a focus on pharmacy. Understanding Pharmacy Reimbursement is the essential resource that allows you to more effectively deal with the rapidly changing and constantly emerging reimbursement issues over the next few years. |
| interqual and milliman training: The Prospective Review , 1851 |
| interqual and milliman training: Be A Giant Killer Ed Norwood, 2021-08-17 SINCE THE DAY YOU WERE BORN, there have been giants in your life. Tyrants of immense size who try to exert negative influence over your destiny. Giants try to intimidate you into inaction and apathy. They want to convince you that your past mistakes, family tree, size, and shame will always hold you back. I, too, was born with giants. When I was eight years old, twenty-seven of my relatives were massacred by cult leader Jim Jones in the Jonestown Guyana Tragedy. The shame of my own family history shadowed my life until I discovered the lessons revealed in this book, a searing expose of how our history can influence our legacy. We were made to break the cycle and, just like men and women in the Bible, fiercely face the giants in our lives before they get passed to the next generation. Be A Giant Killer is a knockout punch to what's holding you back from your wildest dreams and best life! Powerful and impactful! Ed is an incredible man and friend with a very unique personal story. His passion is contagious! He identifies God's dreams for His children and the giants in the way of fulfilling these dreams. This is a must-read for anyone excited to use biblical weapons to help defeat these giants in life and chase their dreams! Get reading and let's go! -BRUCE TOLLNER, Co-Author of Sidelined with Indianapolis Colts Coach Chuck Pagano/NFL Agent/ Owner Rep 1 which represents Jared Goff, Carson Wentz, Marcus Mariota, Ben Roethlisberger and many others. In Be A Giant Killer, Ed Norwood equips the reader to be able to readily identify the enemies that hinder us, and then conquer them. Defining the problem well is half the battle. This is gold to those who are ready to be victorious warriors. -BISHOP DALE C. BRONNER, D. MIN., Founder/Senior Pastor, Word of Faith Family Worship Cathedral, Atlanta, GA |
| interqual and milliman training: CMSA Core Curriculum for Case Management , 2008 This text contains the core body of knowledge for case management practice as delineated by the Case Management Society of America (CMSA), the largest professional organization of case managers. The core curriculum provides a synthesis of case management evolution, and presents essential elements, concepts, and vision for current and future case management practice. This edition is significantly expanded to reflect the dynamic changes taking place in case management. Each chapter is organized in a consistent format that includes learning objectives; introduction; important terms and concepts; key definitions; and references. |
| interqual and milliman training: Addiction Treatment Matching David R. Gastfriend, 2004 Also appearing as Journal of Addictive Diseases, v. 22, supplement number 1 (2003), this book contains ten research studies by experts in mental health and addiction services. It specifically examines the ASAM Patient Placement Criteria, with an eye toward its effect on health plans, treatment programs, and patients. The editor is a medical doctor affiliated with the addiction research program at Massachusetts General Hospital and a professor at Harvard Medical School. Annotation : 2004 Book News, Inc., Portland, OR (booknews.com). |
| interqual and milliman training: Clinical Practice Guidelines Institute of Medicine, Committee to Advise the Public Health Service on Clinical Practice Guidelines, 1990-02-01 The Alberta clinical practice guidelines program is supporting appropriate, effective and quality medical care in Alberta through promotion, development and implementation of evidence-based clinical practice guidelines. |
| interqual and milliman training: Gulf War and Health Institute of Medicine, Division of Health Promotion and Disease Prevention, Committee on Health Effects Associated with Exposures During the Gulf War, 2000-12-28 The men and women who served in the Gulf War theater were potentially exposed to a wide range of biological and chemical agents. Gulf War and Health: Volume 1 assesses the scientific literature concerning the association between these agents and the adverse health effects currently experienced by a large number of veterans. |
| interqual and milliman training: Healthplan , 2002 |
| interqual and milliman training: Knowing What Works in Health Care Institute of Medicine, Board on Health Care Services, Committee on Reviewing Evidence to Identify Highly Effective Clinical Services, 2008-05-29 There is currently heightened interest in optimizing health care through the generation of new knowledge on the effectiveness of health care services. The United States must substantially strengthen its capacity for assessing evidence on what is known and not known about what works in health care. Even the most sophisticated clinicians and consumers struggle to learn which care is appropriate and under what circumstances. Knowing What Works in Health Care looks at the three fundamental health care issues in the United States-setting priorities for evidence assessment, assessing evidence (systematic review), and developing evidence-based clinical practice guidelines-and how each of these contributes to the end goal of effective, practical health care systems. This book provides an overall vision and roadmap for improving how the nation uses scientific evidence to identify the most effective clinical services. Knowing What Works in Health Care gives private and public sector firms, consumers, health care professionals, benefit administrators, and others the authoritative, independent information required for making essential informed health care decisions. |
| interqual and milliman training: Inpatient Versus Observation Status Vivienne Martin, 2021-05-31 Inpatient vs. Observation status is a convenient pocket-size guide that equips admitting providers to determine a patient's admission status quickly, easily, and effectively. This pocket-sized guide contains tables and generally accepted guidelines for practitioners who admit patients. Each topic is usually covered on a single page, with an accompanying chart on the facing page, allowing for quick decision-making of the patient's admission status (inpatient versus observation). This makes it precise and easy to comprehend. By matching clinical findings with criteria charts, providers are able to quickly and easily determine if a patient is appropriate for inpatient or observation admission status. In addition, by providing tips for documentation you are able to write the correct admission orders initially, avoiding the headaches of time-consuming changes later, penalties, and/or loss of revenue.This pocket-size guide is ideal for physicians, medical students, interns, residents, NPs, PAs, dentists, and anyone else responsible for assigning the correct admission status. |
| interqual and milliman training: Clinical Practice Guidelines We Can Trust Institute of Medicine, Board on Health Care Services, Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, 2011-06-16 Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review-guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers. |
| interqual and milliman training: Conscientious Objection in Health Care Mark R. Wicclair, 2011-05-26 Historically associated with military service, conscientious objection has become a significant phenomenon in health care. Mark Wicclair offers a comprehensive ethical analysis of conscientious objection in three representative health care professions: medicine, nursing and pharmacy. He critically examines two extreme positions: the 'incompatibility thesis', that it is contrary to the professional obligations of practitioners to refuse provision of any service within the scope of their professional competence; and 'conscience absolutism', that they should be exempted from performing any action contrary to their conscience. He argues for a compromise approach that accommodates conscience-based refusals within the limits of specified ethical constraints. He also explores conscientious objection by students in each of the three professions, discusses conscience protection legislation and conscience-based refusals by pharmacies and hospitals, and analyzes several cases. His book is a valuable resource for scholars, professionals, trainees, students, and anyone interested in this increasingly important aspect of health care. |
| interqual and milliman training: Nursing Case Management Suzanne K. Powell, 1996 |
| interqual and milliman training: The Healthcare Imperative Institute of Medicine, Roundtable on Evidence-Based Medicine, 2011-01-17 The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers. |
| interqual and milliman training: Children's Health Insurance Program Reauthorization Act of 2009 United States, 2009 |
| interqual and milliman training: Conference on Life and Health Insurance Litigation , 2000 |
| interqual and milliman training: Textbook of Neural Repair and Rehabilitation Michael E. Selzer, Stephanie Clarke, Leonardo G. Cohen, Gert Kwakkel, Robert H. Miller, 2014-04-24 Volume 2 of the Textbook of Neural Repair and Rehabilitation stands alone as a clinical handbook for neurorehabilitation. |
| interqual and milliman training: The Growth of Incarceration in the United States Committee on Causes and Consequences of High Rates of Incarceration, Committee on Law and Justice, Division of Behavioral and Social Sciences and Education, National Research Council, 2014-12-31 After decades of stability from the 1920s to the early 1970s, the rate of imprisonment in the United States has increased fivefold during the last four decades. The U.S. penal population of 2.2 million adults is by far the largest in the world. Just under one-quarter of the world's prisoners are held in American prisons. The U.S. rate of incarceration, with nearly 1 out of every 100 adults in prison or jail, is 5 to 10 times higher than the rates in Western Europe and other democracies. The U.S. prison population is largely drawn from the most disadvantaged part of the nation's population: mostly men under age 40, disproportionately minority, and poorly educated. Prisoners often carry additional deficits of drug and alcohol addictions, mental and physical illnesses, and lack of work preparation or experience. The growth of incarceration in the United States during four decades has prompted numerous critiques and a growing body of scientific knowledge about what prompted the rise and what its consequences have been for the people imprisoned, their families and communities, and for U.S. society. The Growth of Incarceration in the United States examines research and analysis of the dramatic rise of incarceration rates and its affects. This study makes the case that the United States has gone far past the point where the numbers of people in prison can be justified by social benefits and has reached a level where these high rates of incarceration themselves constitute a source of injustice and social harm. The Growth of Incarceration in the United States examines policy changes that created an increasingly punitive political climate and offers specific policy advice in sentencing policy, prison policy, and social policy. The report also identifies important research questions that must be answered to provide a firmer basis for policy. This report is a call for change in the way society views criminals, punishment, and prison. This landmark study assesses the evidence and its implications for public policy to inform an extensive and thoughtful public debate about and reconsideration of policies. |
| interqual and milliman training: Child Health Nursing Jane W. Ball, Ruth C. Bindler, Kay J. Cowen, Michele Rose Shaw, 2018-04-23 For courses in Pediatric Nursing. A comprehensive survey of family-centered pediatric nursing care Child Health Nursing: Partnering with Children & Families promotes excellence in nursing care for infants, children, and adolescents--in hospitals and in the community. It focuses on the importance of partnering with families to adapt care plans for children based on their age, health status, and social and cultural influences. The text considers the impact of contemporary care environments on nursing practice, both in health promotion and in the care of children with acute or chronic health conditions. By offering industry best practices and practical applications, the book encourages students to apply evidence-based findings and clinical reasoning to planning superior care. The updated 3rd edition explains how modern nursing practice is affected by reforms to healthcare and its delivery-such as electronic health records, new approaches to chronic and acute condition management, and a focus on prevention. To support safe, effective, and innovative care, this edition draws on the latest recommendations of NANDA International diagnoses, Nursing Intervention Classifications (NIC), Nursing Outcomes Classifications (NOC), and Healthy People 2020. Also available with MyLab Nursing MyLab(tm) Nursing is an online self-study and class preparation program designed to engage students and improve results. Its personalized learning path helps students think like nurses as they move beyond memorization to true understanding through application. Learn more. Note: You are purchasing a standalone product; MyLab Nursing does not come packaged with this content. Students, if interested in purchasing this title with MyLab Nursing, ask your instructor to confirm the correct package ISBN and Course ID. Instructors, contact your Pearson representative for more information. If you would like to purchase both the physical text and MyLab Nursing search for: 0134874439 / 9780134874432 Child Health Nursing Plus MyNursingLab with Pearson eText -- Access Card Package Package consists of: 0134624726 / 9780134624723 Child Health Nursing 013486946X / 9780134869469 MyNursingLab with Pearson etext -- Access Code -- for Child Health Nursing |
| interqual and milliman training: Journal of the American Medical Association , 2010-03 |
| interqual and milliman training: Guidelines for Perinatal Care American Academy of Pediatrics, American College of Obstetricians and Gynecologists, 1997 This guide has been developed jointly by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, and is designed for use by all personnel involved in the care of pregnant women, their foetuses, and their neonates. |
| interqual and milliman training: Case Management Suzanne K. Powell, Hussein M. Tahan, 2018-02-26 Prepare for a new career as a case manager—or just upgrade your skills to a whole new level—with the newly updated Case Management: A Practical Guide for Education and Practice, 4th Edition. Ideal for case management certification (CCMC) exam preparation, this is a thorough review of the case manager’s many roles and skills, from acute to post-acute care. Whether you are a nurse transitioning to case management or already active in it, this is your road map to coordinating successful patient care, from hospital to home. Build a strong case management career foundation, with expert, evidence-based direction: NEW chapter on case manager orientation programs that offers orientation checklists, competency assessment, and learning profiles, with available online tools NEW topics on current practice issues and developments, including the impact of the Patient Protection and Affordable Care Act and value-based care NEW content on experiential, problem-based learning—learning practices, training programs, case management team professional development Offers in-depth, evidence-based guidance on: The case manager’s roles, functions, and tasks Key concepts—quality management and outcomes evaluation, legal and ethical considerations, case management process, utilization management, transitions of care The role of the nurse case manager versus social worker role Strategies that ensure effectiveness of case management models Coordinating care, protecting privacy and confidentiality, health insurance benefit analysis, practice standards The Case Management Code of Professional Conduct, accreditation agencies and standards, specialty board certifications Management of resources and reimbursement concepts Case management in various settings—acute care, emergency department, admissions, perioperative services, disease management, insurance case management, palliative care, end-of-life care, hospice, home health care, physician groups, public health/community-based care, rehabilitation Ideal preparation for the CCMC exam—offers a large portion of CCMC exam content—and for Continuing Education Unit (CEU) for Case Management study A must-have desk reference that offers plentiful case studies—considered to be “the bible” of case management |
| interqual and milliman training: Lymphedema Management Joachim Ernst Zuther, 2011-01-01 A well-written textbook that is clear and concise. The organization is exceptional; each chapter is color-coded for ease in locating or browsing through information, and colored shadings in the text emphasize important points. Students and patients interested in this topic will find exceptional value in reading this book. The quality and readability are excellent. --Physical TherapyThis comprehensive textbook discusses current approaches to managing primary and secondary lymphedema and related conditions, such as chronic venous insufficiency, edema, and rheumatoid arthritis. It provides thorough coverage of the anatomy, physiology, and pathology of the lymphatic system, and explains everything you need to know about manual lymph drainage (Vodder technique), complete decongestive therapy, and other treatment modalities. The authors also provide practical tips on patient self-care, bandaging techniques, and exercises, and give valuable recommendations for administrative and business issues.Highlights of this second edition: New sections on axillary web syndrome, Klippel-Trenaunay syndrome, and Parkes Weber syndrome Expanded coverage of the circulatory and lymphatic systems, lipedema, and important considerations for treatments Up-to-date information on the care of wounds and skin lesions Lymphedema Management is an indispensable reference for physicians, therapists, nurses, and students who wish to gain full understanding of this complex topic and maximize treatment success. Lymphedema patients will also greatly benefit from its wealth of hands-on information and helpful illustrations. |
| interqual and milliman training: Core Curriculum for Medical Quality Management American College of Medical Quality, 2005 Core Curriculum for Medical Quality Management addresses the needs of physicians, medical students, and other health care professionals for current information about medical quality management, principles, methods, programs, systems, and experiences. This book presents a true state-of-the-nation assessment of medical quality management and highlights the need for training of physicians who will lead the medical quality movement in the 21st century. Each contributing author is a recognized leader in medical quality management. The reader should find this to be a highly readable basic text to acquire a sound initial working knowledge of medical quality management. |
| interqual and milliman training: Nursing Case Management Elaine Cohen, Toni G. Cesta, 2004-08-26 This classic resource offers complete coverage of nursing case management - from theoretical background and historical perspective to practical applications and how the field is changing to meet the challenges of today's health care environment. It focuses on the implementation of various case management models used throughout the United States and abroad. Key topics include the impact of public policy on health care; understanding the effects of health care reimbursement and its application at the patient level; throughput and capacity management; the impact of the revenue cycle; compliance and regulatory issues; and principles needed to improve case manager-client interaction. This helpful resource is designed to help nurse case managers assess their organization's readiness for case management, prepare and implement a plan to achieve necessary improvements and evaluate the plan's success. Includes numerous proven case management models currently being used in institutions across the country Organized to take the nursing case manager on a journey from the historical development of nursing case management to the successful implementation of a case management program Offers detailed guidance for planning, implementing, and evaluating a case management program Outlines the planning process with information on key topics such as analysis of the organization, the role of the organization's members, selection criteria for new case managers, case management education, credentialing, and partnerships Features guidelines for implementing a case management program with information on ethical issues, technology, compliance, and regulatory issues Addresses the evaluation component of developing and implementing a case management program by presenting information on outcomes, research, documentation, continuous quality improvement, measuring cost effectiveness, care continuum, and evidence-based practice Presents acute care and community based models of case management Highlights the evolution of collaborative models of case management, addressing key elements of joint decision-making, shared accountability, and interdisciplinary systems of care Addresses health care delivery through case management and public policy by presenting current legislative issues and their affect on both health care reimbursement and the application of care at the patient level Presents the insights, experiences, and advice of nursing administrators who have researched and successfully implemented nursing case management programs in various facilities |
| interqual and milliman training: Conditions of Participation for Hospitals United States. Social Security Administration, 1966 |
| interqual and milliman training: Cognitive Rehabilitation for Pediatric Neurological Disorders Gianna Locascio, Beth S. Slomine, 2018-08-02 A professional guide to evidence-based pediatric cognitive rehabilitation in neurological disorders with practical intervention guidance. |
| interqual and milliman training: Principles and Practice of Hospital Medicine, Second Edition Sylvia C. McKean, John J. Ross, Daniel D. Dressler, Danielle Scheurer, 2016-10-22 The leading textbook of hospital medicine – completely updated to reflect today’s challenges A Doody’s Core Title for 2021! Since its publication in 2012, Principles and Practice of Hospital Medicine, Second Edition has become the field’s premier resource. Comprehensive, authoritative, and practical, this landmark text provides a solid grounding in clinical, organizational, and administrative areas central to the practice of hospital medicine. The Second Edition has been completely updated to reflect the evolving practice responsibilities of hospitalists. Examples include value-based medicine, expanded surgical content, bedside clinical reasoning, and a new segment devoted to rehabilitation and skilled nursing care. This edition also features a more accessible and streamlined full-color design enriched by more than 600 illustrations. Each clinical chapter opens with boxed Key Clinical Questions that are addressed in the text and summarized in hundreds of tables. Case studies demonstrate how to apply this information specifically to the management of hospitalized patients. Representing the expertise of more than two hundred renowned contributors, Principles and Practice of Hospital Medicine, Second Edition is logically divided into six sections: The Specialty of Hospital Medicine and Systems of Care Medical Consultation Rehabilitation and Skilled Nursing Care The Approach to the Patient at the Bedside Diagnostic Testing and Procedures Clinical Conditions in the Inpatient Setting Principles and Practice of Hospital Medicine, Second Edition is essential reading for clinicians who strive to optimize inpatient care and sharpen their leadership skills. |
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Interqual and Milliman training provides a vital framework for healthcare professionals to navigate the complexities of utilization management and ensure appropriate and cost-effective care. By …
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InterQual and Milliman Training: Mastering the Art of Utilization Management In the ever-evolving healthcare landscape, optimizing resources and ensuring appropriate patient care are …
Interqual And Milliman Training Full PDF - netsec.csuci.edu
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Interqual And Milliman Training Legal Nurse Consulting 2002-11-26 Patricia W. Iyer, MSN, RN, LNCC Designed to meet the needs of both novice and advanced practitioners, the first edition …
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Core Skills for Hospital Case Managers is an orientation and training manual for nurses transitioning into case management, an easy-to-read reference guide for new case managers, …
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InterQual and Milliman Training: Mastering the Art of Utilization Management In the ever-evolving healthcare landscape, optimizing resources and ensuring appropriate patient care are …
Interqual And Milliman Training Full PDF - netsec.csuci.edu
interqual and milliman training: Healthcare Money Campfire Stories Eric Bricker, 2019-11 Learn 16 Ways Money Influences Healthcare and the Practice of Medicine That You Have Never Seen …
Interqual And Milliman Training (book) - peerlessindustrial.com
orientation and training manual for nurses transitioning into case management an easy to read reference guide for new case managers and a source of inspiration tools and resources for …
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3 Interqual And Milliman Training Published at 88.80.191.195 these three lessons along with 13 more through a series of stories that are short, suspenseful and sometimes funny... just like a …
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Interqual And Milliman Training JA Banks The Case Manager's Training Manual David W. Plocher,Patricia L. Metzger,2001 Stem Cell and Bone Marrow Transplantation Commerce …
Interqual And Milliman Training Full PDF - companyid.com
Finally an affordable effective and consistent training program for your hospital case managers This one of a kind guide to fundamental case management responsibilities is a necessary …
Interqual And Milliman Training (PDF)
Interqual And Milliman Training Case Management Suzanne K. Powell,2000 The Second Edition of this comprehensive how to text has been completely revised and updated. This text outlines …
Interqual And Milliman Training [PDF]
Interqual And Milliman Training Pauline Sanders RN The Case Manager's Training Manual David W. Plocher,Patricia L. Metzger,2001 Stem Cell and Bone Marrow Transplantation
Interqual And Milliman Training - myms.wcbi.com
interqual-and-milliman-training 1/5 Downloaded from myms.wcbi.com on 28-12-2023 by Guest Interqual And Milliman Training Clinical Practice Guidelines We Can Trust 2011-06-16 Institute …
Interqual And Milliman Training [PDF]
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Interqual And Milliman Training - wiki.drf.com Finally--an affordable, effective, and consistent training program for your hospital case managers. This one-of-a-kind guide to fundamental …
Interqual And Milliman Training - 88.80.191.195
3 Interqual And Milliman Training Published at 88.80.191.195 these three lessons along with 13 more through a series of stories that are short, suspenseful and sometimes funny... just like a …
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training program for your hospital case managers. This one-of-a-kind guide to fundamental case management responsibilities is a necessary reference tool for every hospital case management...
Interqual And Milliman Training - wiki.drf.com
training program for your hospital case managers. This one-of-a-kind guide to fundamental case management responsibilities is a necessary reference tool for every hospital case management...
Interqual And Milliman Training - chat.ajre.gov.ae
Interqual And Milliman Training Legal Nurse Consulting 2002-11-26 Patricia W. Iyer, MSN, RN, LNCC Designed to meet the needs of both novice and advanced practitioners, the first edition …
Interqual And Milliman Training [PDF]
Interqual And Milliman Training The Case Manager's Training Manual David W. Plocher,Patricia L. Metzger,2001 Stem Cell and Bone Marrow Transplantation Commerce Business Daily …
Interqual And Milliman Training - portal.ksa.ac.ke
Core Skills for Hospital Case Managers is an orientation and training manual for nurses transitioning into case management, an easy-to-read reference guide for new case managers, …
Interqual And Milliman Training - Daily Racing Form
Interqual And Milliman Training - wiki.drf.com WEBFinally--an affordable, effective, and consistent training program for your hospital case managers. This one-of-a-kind guide to fundamental...
