Founded in 1926, Glendale Memorial Hospital and Health Center is a 334-bed, acute care, nonprofit, community hospital located in Glendale, California. The hospital offers a full complement of services, including its award winning heart center, the colorectal surgery institute, a gastrointestinal program, and is a Los Angeles County approved primary stroke center. The hospital shares a legacy of humankindness with Dignity Health, one of the nation’s five largest health care systems. Visit here https://www.dignityhealth.org/socal/locations/glendalememorial for more information.
Responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking. Collaborates with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies. Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions. Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market.
Preferred