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Hospital bedside discussion explaining our Care Management/Disease Management program with verbal introduction to their Community Care Manager for home visit once discharge to home from either inpatient or skilled nursing facility (SNF.
Full-timeExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
$315,732.79 a year depends on education, experiencePart-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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The RN-Care Manager in Primary Care is a team member who provides comprehensive and coordinated nursing care to an assigned panel of patients and who collaborates with VA and community services to effectivity meet the health promotion or disease prevention, acute, chronic, and long-term needs, based on the Veteran's goals and plan of care.
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The Care Manager - RN is a key member of an integrated Care Team which includes a an Advanced Practice Provider and a Social Worker. Monogram’s in-home approach utilizes a national nephrology practice supported by case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs.
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You will consult with clinic-level staff regarding delegated utilization management and disease management operations under managed care contracts. You will attend meetings sponsored by AFC corporate to train and support quality improvement, risk management, patient safety, case management, medical staff affairs, and provider relations activities.
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Medical record review experience directly working on HEDIS/QARR in a managed care setting. Collaborates with other departments to maximize member outreach for preventive services and chronic disease management.
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Complete HEDIS and all other clinical alerts tasked to a medical assistant role per protocols including management of home monitoring systems if applicable Deliver on excellent customer service for every member including assisting with care coordination needs such referrals, enrollments in chronic disease management programs, etc.
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Health education provided regarding prenatal care, newborn care, EPSDT guidelines, chronic disease management, preventive health screenings, dental care and mental health services.
Full-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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Serves as a broker in obtaining identified resources for the client; focuses on changing from retrospective, episodic case management to a prospective system of health maintenance, disease prevention and management.
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You will have the opportunity to practice medicine as it should be and utilize all of your clinical skills-preventative care, chronic disease management, acute care and office-based procedures.
ExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Experience in Utilization/Quality Program managementHMO/Managed care experiencePREFERRED LICENSE, CERTIFICATION, ASSOCIATION:Board Certification (Primary Care preferred). Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most effective setting.
$315,732.79 a year depends on education, experienceFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Responsible for Corporate reporting and analysis, managed care, third-party reimbursement, and management of accounts receivable, i.e., bad debt and cash collections. Since 1969, Lakeside has been the premier provider of specialized behavioral health and addictive disease services in the Memphis and Mid-South region.
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Certified Provider Credentialing Specialist (CPCS) certification and/or Certified Professional Medical Staff Management (CPMSM) certification or the ability to obtain CPCS or CPMSM within 18 months of hire.
$53.2 - $79.8 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Reporting to the Chief Medical Officer, this position provides clinical leadership and oversight of the population health management program including utilization management, case management, preventive health/disease management, and quality management while supporting the multidisciplinary member-centric approach to care management.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Assigning service requests and outreach activities from various internal departments, such as Provider Relations, Utilization Management, Case Management/Disease Management, and IT Enrollment, to the appropriate team members in the Member Services Outbound Unit for processing.
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