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The Licensed Behavioral Health Clinician works alongside medical Utilization Management and medical Care Management staff, pharmacists, and medical directors as part of an integrated team and follows members through the health care continuum, including acting as the liaison for hospital staff, PCPs, and other healthcare team members in facility discharge planning.
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Behavioral Health Utilization Management Clinician - Fully remote. The Behavioral Health Utilization Management Clinician is responsible for conducting utilization and quality management activities in accordance with New York State and MetroPlusHealth Utilization Management policies and procedures.
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LifeBridge Health includes Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital and Grace Medical Center, as well as our Community Physician Enterprise, Center for Hope, Practice Dynamics, and business partners: LifeBridge Health & Fitness, ExpressCare and HomeCare of Maryland.
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Occ SummaryIn conjunction with the Health System Director, this position provides daily operational oversight, management and leadership for staff of the Case Management Department whose activities are associated with the continuum of care, clinical cost reduction, utilization management, care transitions, population management, clinical social work, quality, performance improvement, reimbursement and discharge planning.
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Reports directly to the JHH VP of Care Coordination/Utilization Management and indirectly to the JHBMC Senior Director of Care Management and is responsible for the coordination, management and success of The Johns Hopkins Hospital and The Johns Hopkins Bayview Medical Center Utilization Management programs.
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Supervise direct staff to ensure effective utilization of referral services and community relations opportunities including scheduling employees, identifying and addressing training needs and implementing a system of on-going employee performance monitoring.
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Established in 1986, our high-tech and high-touch offerings include innovative medical management systems, face to face community care coordination services, utilization review, clinical data integration and business intelligence analytical reporting – all focusing on increased quality outcomes and optimization of provider and payer networks.
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Is responsible for the daily operation as well as specialty programs which encompass transition planning, social work, clinical resource and utilization management. Collaborates with leadership at Windham Hospital to provide cohesive program management with the Regional Director of care management.
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Works with hospital and clinical staff to initiate and coordinate early discharge through collaboration with specialists, nursing staff, social services, utilization management, and other members of the interdisciplinary team.
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Experience in working in Utilization Management, Transitional Care Management, and Chronic Care Management. One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance.
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Provides leadership, resource, and oversight of the care management team at Backus Hospital. We are home to the only trauma center in New London and Windham counties, and are the only area hospital with LIFE STAR helicopter services.
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Develops and maintains a positive working relationship with the Physician Advisor of the facility to ensure correct patient classifications, timely denials management, and development of collaboration with physician members and other departmental leaders within the hospital.
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O Ensures updates and maintenance of hospital plans is completed (for example Plan for the Provision of Care/Scope of Services, Leadership, Information Management, Utilization Review, Infection Control, Performance Improvement and Patient Safety.
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The Director is responsible for hospital-wide quality management program and works with hospital administration, departments, and the medical staff to monitor and evaluate the quality of delivery of patient care services within the hospital.
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5 Years experience in Case Management or Utilization Management in either a hospital or insurance company (Required) The Director of Care Management has overall responsibility for all utilization review activities on the TUH Jeanes Campus as defined by TUHS contracts, as falls within the scope of practice of the Care Management Department and is necessary to meet the financial needs of the organization.
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hospital management utilization jobs
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