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Case Management Utilization Review Skills Checklist |
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| NAME | |||||||||
| LAST 4 OF SSN | |||||||||
| DATE | |||||||||
| I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination. | |||||||||
| Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below. | |||||||||
| Proficiency Scale: |
1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently |
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| Rating Stars (Click) | SETTING | 1 | 2 | 3 | 4 | ||||
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Acute Care | ||||||||
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Skilled/LTAC | ||||||||
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MDS Coordinator | ||||||||
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Home Health | ||||||||
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Telephonic | ||||||||
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Workers Compensation | ||||||||
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Insurance | ||||||||
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Managed Care | ||||||||
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Acute Rehab | ||||||||
| Rating Stars (Click) | CM/UR SOFTWARE | 1 | 2 | 3 | 4 | ||||
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Interqual | ||||||||
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Milliman | ||||||||
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MIDAS | ||||||||
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Allscripts UR | ||||||||
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Word Processing Software | ||||||||
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Other: Specify | ||||||||
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Other: Specify | ||||||||
| Rating Stars (Click) | REGULATORY | 1 | 2 | 3 | 4 | ||||
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CMS/Medicare | ||||||||
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HEDIS Measures | ||||||||
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Core Measures | ||||||||
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Medicaid/Medical | ||||||||
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DRG | ||||||||
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ICD 9 Coding | ||||||||
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ICD 10 Coding | ||||||||
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CPT | ||||||||
| Rating Stars (Click) | PROCESSES | 1 | 2 | 3 | 4 | ||||
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Benefits Eligibility | ||||||||
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Pre-Certification Review | ||||||||
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Review for Admission Criteria | ||||||||
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Identify Appropriate Level of Care | ||||||||
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Review Status During Stay | ||||||||
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Discharge Planning | ||||||||
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Physician Advisor | ||||||||
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Clinical Documentation Improvement | ||||||||
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Needs Assessment/Order DME | ||||||||
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Needs Assessment/Home Health | ||||||||
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Needs Assessment/Hospice | ||||||||
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Needs Assessment/Skilled | ||||||||
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Third Party Authorization Process | ||||||||
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Concurrent Review | ||||||||
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Retrospective Review | ||||||||
| Rating Stars (Click) | PROFESSIONAL KNOWLEDGE AND SKILLS | 1 | 2 | 3 | 4 | ||||
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National Patient Safety Goals | ||||||||
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Age Specific/Population Based Care | ||||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||||
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Infant (Birth - 1 year) | ||||||||
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Preschooler (ages 2-5 years) | ||||||||
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Childhood (ages 6-12 years) | ||||||||
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Adolescents (ages 13-21 years) | ||||||||
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Young Adults (ages 22-39 years) | ||||||||
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Adults (ages 40-64 years) | ||||||||
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Older Adults (ages 65-79 years) | ||||||||
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Elderly (ages 80+ years) | ||||||||
| Rating Stars (Click) | EMR | 1 | 2 | 3 | 4 | ||||
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Epic | ||||||||
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Cerner | ||||||||
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Eclipsys | ||||||||
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McKesson | ||||||||
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Meditech | ||||||||
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Allscripts | ||||||||
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Other: Specify | ||||||||
| EMR Conversion |
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| CERTIFICATIONS | Expiry Date : | ||||||||
| BLS | |||||||||
| Certified Case Manager (CCM) | |||||||||
| Accredited Case Manager (ACM) | |||||||||
| Certified Disability Management Specialist (CDMS) | |||||||||
| Certified Clinical Documentation Specialist (CDMS) | |||||||||
| ACLS | |||||||||
| Other: Please note any ICD 10 training | |||||||||
| Other: Specify | |||||||||