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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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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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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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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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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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Formulates a clear and concise clinically based or administrative argument to denial rationales supported by clinical criteria, including but not limited to, CMS, Florida Medicaid, CFR, Health Plan, InterQual (IQ), Milliman Care Guidelines (MCG), and UpToDate.
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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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Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies. Applies MCG criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Departmental standards.
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Provides support for the assignment and follow up on Milliman Care Guidelines (MCG) when assigned. Provides support for the assignment and follow up on Milliman Care Guidelines (MCG) when assigned.
Full-timeExpandApply NowActive JobUpdated 28 days ago - UpvoteDownvoteShare Job
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Performs chart reviews and quality assessments on all patients using MCG criteria and secondary review as directed by Administration and the Medical Staff or as per contract or payer expectation (UR Committee.
$52.85 - $78.11 an hourFull-timeExpandApply NowActive JobUpdated 2 months ago - UpvoteDownvoteShare Job
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MCG maintains a drug-free workplace, and maintenance of the same is essential to the safety of its workplace and employees. As a result, candidates may be required to undergo a pre-employment (post-offer) physical and/or drug test subject to applicable law.
$14 - $15 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Reports internal and external delays to the Triad Team.•Collaborates with the health care team and appropriate department in the management of care across the continuum of care by assuring communication with Triad Team and health care team.
$31.28 - $51.61 an hourFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Case Manager will process TAR submissions and maintains knowledge of Interqual and MCG quidelines to evaluate medical necessity for Pre-Admission, admissions or continued stay. Responsibilities The RN Case Manager’s primary role is to obtain all functions associated with Continuum of Care for adult and pediatric patients from Pre-Admission/admitting through post discharge placement.
$50 - $60.59 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Preferred Experience: InterQual or MCG experience. Bryce Scholars Program Scholarship Loan. Preferred License/Registration/Certification: ACM or CCM Certification. You can relax and take a hike outdoors or visit one of the numerous spas.
Full-timeExpandApply NowActive JobUpdated Today
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