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Our role in the emergency room is to respond and provide trauma intervention, grief and loss support, general social work and community resourcing, drug and alcohol assessment and placement, care management, utilization initiatives and readmission goals, and mental health/emotional support.
$30.34 - $51.52 an hourFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Three (3) or more years of any individual or combined experience in quality assurance, utilization management, case management, and/or health care informatics is required. Working knowledge of NCQA HEDIS technical specifications, medical terminology, and health plan processes preferred.
$79,809.6 - $101,774.4 a yearFull-timeExpandApply NowActive JobUpdated 2 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.
Starting at $161,914.25 - $315,732.79 a year depends on education, experienceFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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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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Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required. Participates in strategic planning for and evaluation of the Care Management.
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Experience in medical utilization management, medical quality assurance, quality improvement techniques, risk management and a value-based care environment. Oversee that all NCQA and other accreditation standards are met.
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Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
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Role: Case Management Coordinator-CW. Responsible for after-action items as outcome of Quarterly State Audit Reviews, Annual MERCER Review and NCQA Review. Not looking for new graduates; candidate should have some years of related experience - experience with utilization mgmt., utilization review, hospitality preferred.
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Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM. Previous experience to have a strong understanding of Utilization Management/Case Management practices including, but not limited to, placement (with level of care) criteria (MCG, InterQual), concurrent review, and discharge planning.
$88,854 - $142,166 a yearFull-timeExpandUpdated 7 days ago - UpvoteDownvoteShare Job
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Utilization review, prior authorization, Care management, Case management, interqual, ncqa, ncqa standards. As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team.
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Manages outpatient operations and through nurse supervisor(s) and/or assistant department nurse manager(s) is responsible for the delivery of nursing services and outpatient care which are integrated with business plans and meet or exceed cost, quality, clinical and utilization standards and performance measures.
$124,700 - $161,260 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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The RN Care Manager utilizes clinical expertise and understanding of care management, CMS and NCQA regulatory requirements, quality measures of care, and provides safe and appropriate patient transitions across different levels of care.
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Description As an RN Care Manager, you will function as a clinician, advocate, and educator to achieve optimal clinical and quality outcomes by effectively managing care and resources to reduce unnecessary utilization.
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As the Supervisor, UM Regulatory & Compliance, you play a pivotal role in ensuring the success, productivity, and regulatory compliance for Prior Authorization process within Utilization Management Out-Patient Services.
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Supports wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement. Obtains and organizes drug utilization data, including patient specific and population-based data, in a manner which facilitates clinical review and decisions by Clinical Pharmacist Consultants.
Full-timeExpandApply NowActive JobUpdated 2 days ago
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