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Tracks Skilled (MRA/MCO/MCG/MMP) customers utilizing Case Management Tools to determine continued and appropriate Medicare/Managed Care eligibility and benefit period through regular communications with Regional Care Management Specialist, Business Office and external Case Managers.
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Serves as database administrator and facilitates biannual MCG-IRR testing (Milliman Care Guidelines-Inter Rator Reliability) that is administered to clinical and medical director staff. Serves as database administrator and facilitates biannual MCG-IRR testing (Milliman Care Guidelines-Inter Rator Reliability) that is administered to clinical and medical director staff.
$76,800 - $102,795 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Ensure state pricing files are current and updated in the MCG. Miscellaneous Analysis (20%) Incorporate Supplier pricing updates to be accurately reflected in the MCG. DUTIES & RESPONSIBILITIES: Critical Tasks – Pricing: (40%)ALL Master Cost Grid (MCG) – support the efforts and direction provided by the executive team.
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In-depth knowledge of anatomy and physiology, disease processes, medical and CMS policies, MCG criteria, clinical utilization management, case management or behavioral health management. In-depth knowledge of anatomy and physiology, disease processes, medical and CMS policies, MCG criteria, clinical utilization management, case management or behavioral health management.
Full-timeExpandApply NowActive JobUpdated 17 days ago - UpvoteDownvoteShare Job
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Working experience with medical management criteria such as MCG and/or InterQual. Required Licenses and CertificationsRegistered Nurse in District of Columbia (Required)Basic Life Support for Healthcare Provider (BLS) (Required)CCM or ACMA (certified case manager) (Preferred)Job FunctionsResource Management Lead projects related to payer performance and work with Managed Care and others to address payer specific issues.
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Working toward or completion of CCM/CCP/CDE/MCG certification or Advanced degree. Working toward or completion of CCM/CCP/CDE/MCG certification or Advanced degree. Familiarity of ancillary services including HHC, SNF, Hospice, etc.
RemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Experience with utilization management, knowledge of MCG / criteria, managed care language, and CMS rules and regulations preferred. POSITION SUMMARY: Registered Nurse uses approved screening criteria (MCG/CMS Inpatient List) to determine the medical necessity of a requested hospitalization and the appropriate level of care for that patient.
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MCG is a leading healthcare organization dedicated to patient-focused care. At MCG, we lead the healthcare community to deliver patient-focused care. MCG Health is a Seattle, Washington based company and is considering remote candidates.
$147,500 - $206,500 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Knowledge in the application of guidelines/criteria (ASAM, MCG, ABA) Requires operation of general office equipment to include; PC, fax/copy machine and ACD Mitel Phones. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.
$70,000 - $80,000 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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For information about Montgomery County Government's comprehensive benefits package, please visit the MCG Total Rewards webpage and check out our competitive benefits! For information about Montgomery County Government's comprehensive benefits package, please visit the MCG Total Rewards webpage and check out our competitive benefits.
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Medical Policy Implementation Analyst Sr would have a Bachelor's degree in health science or related field (e.g., nursing, public health) and 5 years of experience in working with medical policies and 3 years of direct clinical experience or equivalent combination of education and experience.
Full-timeExpandApply NowActive JobUpdated 17 days ago - UpvoteDownvoteShare Job
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Must have experience in UM, experience with Turnaround Timeframes, good with computer systems and be able to learn a new system, have done clinical reviews and processed denials and partial denial determinations, know MCG and can use it, case presentation for medical reviews, know Medicaid/ Medicare guidelines.
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Assigns the appropriate Level of Care (LOC) and approves the authorization if deemed medically necessary using MCG or Inter-Qual (CareEnhance Review Manager Enterprise) guidelines. Provides authorization for discharge needs i.e. home health care PT, OT, skilled nursing visits, Home infusion, Self-injectable drugs, DME, medical supplies, etc.
Full-timeExpandApply NowActive JobUpdated 25 days ago - UpvoteDownvoteShare Job
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Responsible for effective utilization review and proper resource management, including patient statusing processes, ongoing monitoring of medical necessity review functions utilizing InterQual and/or MCG screening guidelines, and oversight of clinical denials/appeals.
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Knowledge in criteria set, including MCG, InterQual, ASAM, and LOCUS preferred. This position is available fully remote from Washington, Oregon, Idaho, Texas and Florida. Regularly communicates with the UM Manager, Medical Director, physician advisor/reviewer and primary care physician for support, problem resolution and notification of decertification and appeals.
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