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They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). The RN Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS. CHRISTUS Santa Rosa Hospital - Westover Hills (CSRH-WH) is a 150-bed hospital serving the fastest growing area of San Antonio.
$31.7 - $42.35 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Demonstrated ability in the following skill set: Interpretation of technical data specifications Critical thinking Excel spreadsheet use Problem-solving Research Project management EMR and data aggregator software Communication, verbal and written Presentation Skills ESSENTIAL FUNCTIONS Provides administrative support to ensure success of IPA's Medicare Risk Adjustment, HEDIS and CMS STARS initiatives.
$19 - $27.5 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Officially we title this job a BOM or Business Office Manager, but in other centers it may be called a Medicare / Medicaid Biller or Accounts Receivable Coordinator or even a Financial Services Rep. This is NOT a remote / 'work from home' position.
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Prepare, submit, and scan approximately 1,000 provider enrollment applications per year for Medicare, Medicaid, Blue Cross, Blue Shield, CAQH and other payer programs as needed and is responsible for all aspects of payer portal access for individual providers.
$28.63 an hourFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Contractual arrangements include but are not limited to Medicaid, Commercial, Medicare Advantage, Medicare Accountable Care Organization (ACO) Reach, ACO – Medicaid, Capitation and global shared savings/risk.
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Works with the Landmark Health Medical Director, Director of Health Services, Corporate Director of Health Services, and UM staff in the development and/or implementation of medical management policy, clinical protocols, utilization management guidelines, and quality management programs.
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Qualifications Must be organized, resourceful, self-motivated, and have good verbal and written communication skills Must be proficient in MS Word, Excel, Email, and healthcare-related EMRs Must know about Medicare, Medicaid, and private pay billing practices Must have a High School diploma or equivalent An A.A.S. degree in business, finance, bookkeeping, preferred Proficient in budgeting and financial management, a plus Benefits: Competitive salary, medical, dental, 401k plan, etc.
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This position will prepare, review and file the Medicare and Medicaid cost reports for all OhioHealth entities. Subject matter learning and expert on CMS cost reporting, disproportionate share (DSH), Uncompensated Care, Bad debt reporting, IME/GME, Medicare Wage Index, S-10 reporting, Tricare and 855’s, Ohio Medicaid, HCAP, UPL and Franchise Fee programs.
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Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintain PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator.
$37 an hourFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Knowledge of CMS claims data, including Medicare, Medicaid, and Marketplace, in the IDR or CCW environment with Fee-for-Service ( FFS ) , Medicare Advantage encounter data, Medicaid data in the Transformed Medicaid Statistical Information System ( T-MSIS ) , or Prescription Drug Event ( PDE ) data.
$172,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Relevant experience includes previous industry, utilization management/utilization review experience and care coordination. RN Coordinator - Utilization Management & Discharge PlanningSummaCare - 1200 E Market Ave, Akron, OHPart-Time / 20 Hours / Days (2 days one wk / 3 days next wk)RemoteSummary:While taking direction from the Manager of UM, the UM Coordinator helps daily to prioritize, coordinate, and implement utilization, discharge planning, regulatory and compliance activities with the UM team.
$50.49ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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We CARE for our patients like they are our own FAMILY. Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), require COVID-19 vaccinations for all Medicare and Medicaid certified providers.
$28 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Under the general direction of the UM Outpatient Manager and Supervisor, the Outpatient UM Coordinator, is a high paced position that requires timely processing of authorization requests, verifying eligibility and obtaining additional information as requested by Medical Management or Utilization Management Nurses.
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Assesses, via electronic systems, patient’s insurance plans and benefits, such as MassHealth eligibility and Medicare benefits and facilitates coordination with Patient Financial ServicesPrepares, explains to patients, and documents delivery of the Medicare Important Message and Medicare Outpatient Observation Notice.
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Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator.
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medicare medicaid utilization management jobs Title: utilization review
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