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Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care. Promotes and facilitates effective management of hospital resources from admission to discharge, collaborating with the assigned clinical team to identify patient most likely to benefit from care coordination services to include assessing patients’ risk factors and the need for care coordination, clinical utilization management and the transition to the next appropriate level of care.
ExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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The Medical Director may occasionally speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management.
ExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Positions in this function consult with customers, members, patients, providers, internal departments and/or external third parties on any or all the following: The Clinical Pharmacist will perform telephonic, patient-centered clinical consults focused on Medication Therapy Management (MTM), Care for Older Adults annual comprehensive medication reviews, conduct outreach, and consult to support statin utilization in patients with diabetes and cardiovascular disease.
RemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Ensures nursing records are correctly maintainedParticipates in Pharmacy, Therapeutic, and Strategic Initiatives, Patient Safety/Sentinel Event Committee, Performance Improvement, Electronic Medical Records (EMR), Utilization Management and other process improvement committees/initiatives as directed or assignedSupports Company Initiatives and the application of best practices in clinical settings.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Minimum two (2) years of utilization review, discharge planning, case management or disease management preferred. The Continuum Case Manager RN is responsible for providing comprehensive case management and utilization management services, including discharge planning, to patients across a range of clinical areas.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Deep understanding of healthcare payer economics, and/or other specific healthcare areas such as EMR, Episode grouper, utilization management, value-based care, low value care etc. Familiarity with clinical concepts related to a broad range of clinical conditions and disease states, such as oncology, falls, palliative care, behavioral health and other chronic conditions.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Requires three (3) years of full-time professional registered nursing experience, including two (2) years of full-time experience in Case Management, Disease Management, Quality Assurance, HEDIS and/or Utilization Review.
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The Residential Counselor may be privileged to provide basic health teaching in the areas of nutrition, exercise, dental care, substance abuse prevention, and prevention of injury and illness at home and in the community as well as training in communicable disease prevention.
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Become a part of our caring community and help us put health first. Master's Degree in a quantitative discipline such as Epidemiology, Biostatistics, Economics, Statistics, Clinical Informatics, Mathematics, Data Science, Data Analysis and/or related fields.
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Provides clinical leadership for Utilization Management, Case Management, Disease Management, and Quality Management of Clients in cooperation with solution medical directors and the Chief Medical Officer.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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That includes, but not limited to their disease management physical and behavioral, medication adherence, and utilization of emergency services, hospitalizations, and avoidable complications.
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Field experience providing care management or care coordination required, managing both medical and psychosocial needs of clients. Minimum 3 years’ in prior experience in Case Management in a health care and/or Managed Care setting strongly preferred.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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The provider will help educate and engage patients in their disease process, with the ultimate goals in mind of prolonging disease progression, decreasing hospitalization/ED utilization, assisting with optimal starting of dialysis, and engaging patients in Home Dialysis therapies.
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Experience in supporting clinical quality programs e.g. HEDIS, Care Coordination or Chronic Disease Management. Through patient engagement and EMR utilization, the ACO Medical Assistant acts as a liaison between the patient, care management team and payor to improve patient outcomes and our ability to meet value-based payment and performance activity targets.
Part-timeRemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Relevant experience in one or more of the following healthcare areas preferred:Coordination of community resourcesCare management of diverse patient populationsAmbulatory CareKnowledge of levels of care throughout the health care continuum to include inpatient, emergency care, rehab, home health, hospice, long term acute care, SNF, ICF, ALF with an overall understanding of utilization management and resource management.
Full-timeExpandApply NowActive JobUpdated 4 days ago
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