PruittHealth (PH) was the 14th largest skilled nursing provider in the U. S. providing exceptional care across a wide spectrum of services including: skilled nursing care, assisted & independent living, home health care, end-of-life hospice care, rehabilitation, pharmacy/infusion services & more.
- Managed eleven PH facilities with a case load of up to 100+ patients
- Facilitated initial & retrospective reviews by extensive clinical evaluation & InterQual to establish patient appropriateness for SNF admission
- Utilized protocols & Medicare guidelines to ensure appropriate utilization of services for specific patient populations.
- Performs telephonic & electronic review of clinical data for medical necessity & appropriateness of care to complete & oversee insurance updates & appeals processes
- Communicated with several agencies, insurance companies, case management companies & peer review companies to ensure payment for services provided
- Notified the resident &/or responsible party of discontinuation of skilled services per Medicare guidelines & issued Notice of Medicare Non-Coverage (NOMNC)