Table of Contents

Preface

Introduction

Health Care Provider Job Descriptions

• Medical Director
• PHO Medical Director
• Quality Assurance/Management Medical Director
• Managed Care Organization Medical Director or Chief Medical Officer
• Health Plan Medical Director for Appeals and Grievances
• Physician Advisor
• Other Medical Directors/Physician Advisors
• Primary Physician – job description, work standards
• Medical Record Audit
• Physician Work Standards – Additional considerations
• Mentor Policy
• Primary Physician Coordinated Care Policy
• Physician staffing requirements (by population)
• Office Visits, Primary Physician, by Diagnosis
• Obstacles to effective medical practice
• Hospitalists
• Physician Extenders/Non-physician Clinicians
• Physicians Assistant
• Nurse Midwife
• Licensed Vocational Nurse/Licensed Practical Nurse (LVN/LPN)
• Registered Nurse (RN)
• Charge Nurse
• Nurse Practitioner/Advanced Practice Nurses
• Nurse or PA Endoscopists
• Clinical Director, Utilization Management
• Utilization Management, Managed Care Coordinator/Representative
• UM Nurse Reviewer
• Concurrent Review Nurse Coordinator
• Denial Letter Administrative Assistant
• Managed Care Technicians
• Pharmaceutical Benefits Director
• Utilization/Resource Management Staff – Training and Job Standards
• Utilization/Resource Management – Reviewer Evaluation
• Assessment Tool for UM Staff - worksheet
• Utilization Review Inter-rater Reliability Evaluation
• Audit of UM Procedures
• Referral Coordinator Productivity Tracking Form
• QA Nurse with performance standards
• Case Management
• Case Manager, Primary Care/Ambulatory Care
• Case Manager, Hospital
• Case Manager, Specialty Care
• Case Management Coordinator
• Social Worker, MSW
• Social Worker Case Manager Competency Requirement List
• Social Work Director
• Discharge Planner
• HIPAA Security Officer Job Descriptions
• Compliance Officer
• Medical Group Practice Executive
• Risk Management/Patient Relations - Function and Responsibilities – example
• Health Information Management (HIM) Job Description Resource
• Medical Staff Coordinator
• Medical Translator
• Speech-Language Pathologist - work, credentials

Performance Management Process, generic version

Policy on Policies

References and Resources

Web Sites