HERE IS WHY OUR
UTILIZATION MANAGEMENT, QUALITY ASSESSMENT AND EDUCATIONAL PROGRAMS RECEIVE
RAVE REVIEWS
NJPR has twenty-five
(25) years of Utilization Management and Quality Assessment experience.
We have handled more than 2,000,000 hospital in-patient reviews and assessments.
The NJPR Vice President
of Medical Affairs is a practicing physician certified by the American
Board of Quality Assurance and Utilization Review Physicians.
The Director of Utilization
Management and Quality Assessment is a registered nurse with many years
of experience in patient care, utilization management and quality issues,
as well as formal training in medical legal issues.
NJPR's review staff
are all registered nurses with clinical and utilization management experience.
Among them are former Directors of utilization management departments,
nursing administrators and critical care providers.
The NJPR team of registered
nurses and physician advisors include all clinical backgrounds and many
years of utilization management experience and in-service.
All utilization management,
quality assessment and educational programs are coordinated by NJPR's
Director of Utilization Management and Quality Assessment, and are individualized
to meet each hospital's unique needs.
Physician
Documentation Training
NJPR's physicians
are well experienced in day-to-day practice and are able to discuss medical
issues with their peers in a non-confrontational manner.
Their years in medical
practice and peer review experience enhance their ability to expertly
guide hospital physicians through the myriad of documentation requirements
and its over-all effect on reimbursement.
Utilization
Management / Quality Assessment
The NJPR review staff
of experienced registered nurses and physicians has been providing Utilization
Management, Quality Assessment and related professional support services
for twenty-five (25) years. Their professional backgrounds and experience
allows NJPR to confidently offer various services. The Vice President
of Medical Affairs, a physician, is certified by the American Board of
Quality Assurance and Utilization Review Physicians.
Statutory
Subacute Care Review
NJPR was certified
by the New Jersey Department of Health and Senior Services (DHSS) in August,
1997 to conduct hospital-based subacute unit review and monitoring. All
New Jersey regulations affecting hospital-based subacute care have been
analyzed thoroughly and interpreted carefully, resulting in a comprehensive
review method that has been developed by NJPR and is in active use in
hospital subacute units.
Appeals
of Third-Party Payer Denials
Qualified, experienced
registered nurses and physicians will provide unbiased, neutral, independent
review and written opinions in response to third-party denials.
Interim
Utilization Management Staff Support
NJPR review staff's
familiarity with various criteria and regulations affords the flexibility
and ability to function with ease at varied facilities when vacation time
and illness deplete hospital staff for prolonged periods of time. NJPR
can provide interim review management support to assure the continued
function of the hospital's patient care management.
Department
Evaluations
NJPR's professional
staff conducts on-site concurrent evaluation of Utilization Management
and Quality Assessment programs. Evaluation and critique identify areas
requiring attention in order to enhance your program's effect.
Specialty
Studies
NJPR's professional
staff, experienced in all clinical specialties, can research and evaluate
perceived or existing problems and provide in-depth reports of the findings.
Educational
Programs
NJPR provides education
for new and experienced Utilization Management personnel to assure familiarity
with criteria, regulations and the Utilization Management process without
interruption of your hospital's day-to-day activities. NJPR alleviates
the problem of diverting management and staff time for the training of
new employees.
Educational programs
are presented at a site selected by the client to permit maximum staff
participation and benefit and are individually tailored to meet each hospital
department's specific needs and encompass history and theory, clinical
criteria, relevant interventions and the reconsideration process.
Legal Nurse
Consultant
NJPR provides the
services of a formally-trained Legal Nurse Consultant to research and
assist in the preparation of Medical Malpractice, Product Liability, Worker's
Compensation, Administrative Law, and other medical legal issues.
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