Case Management Utilization Review
Name
Email
LAST 4 OF SSN
This checklist was electronically signed on (Today’s date)
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
Acute Care
Skilled/LTAC
MDS Coordinator
Home Health
Telephonic
Workers Compensation
Insurance
Managed Care
Acute Rehab
Interqual
Milliman
MIDAS
Allscripts UR
Word Processing Software
Other: Specify
CMS/Medicare
HEDIS Measures
Core Measures
Medicaid/Medical
DRG
ICD 9 Coding
ICD 10 Coding
CPT
Benefits Eligibility
Pre-Certification Review
Review for Admission Criteria
Identify Appropriate Level of Care
Review Status During Stay
Discharge Planning
Physician Advisor
Clinical Documentation Improvement
Needs Assessment/Order DME
Needs Assessment/Home Health
Needs Assessment/Hospice
Needs Assessment/Skilled
Third Party Authorization Process
Concurrent Review
Retrospective Review
National Patient Safety Goals
Age Specific/Population Based Care
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)
Epic
Cerner
Eclipsys
McKesson
Meditech
Allscripts
EMR Conversion
BLS
✔
Certified Case Manager (CCM)
Accredited Case Manager (ACM)
Certified Disability Management Specialist (CDMS)
Certified Clinical Documentation Specialist (CCDS)
ACLS
Other: Please note any ICD 10 trainin
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.
