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Evaluation of Members: -Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
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The therapist is responsible for the clinical oversight and clinical interventions related to the Preliminary Action Plan (PAP), Crisis Management Plan (CMP) and the Case Service Plan in coordination with the in-Circle Program team and CPS case worker.
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In addition, your experience must include: Experience with the Internal Revenue Code and related rulings, regulations, and court decisions to technically complex income tax issues, tax shelters, penalties, and other programs and operations in order to review Appeals Case Memorandums and develop settlements on unique and unprecedented tax issues.
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Collaborates and communicates with the patient/family, RN Case Manager, Patient Care Manager, RN Supervisors, Physician, Referral Source, and Hospice Interdisciplinary Team to ensure optimal coordination of care for each patient/family and to participate in the development and monitoring of the plan of care to ensure effective patient case management.
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2 years of Acute Care experience (can consider 1.5 years) Experience with Utilization Review and Discharge Planning Experience with InterQual All travelers are expected to float between all facilities within a given state.
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Works with Utilization Review staff relative to data tracking for performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process.
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Previous experience with case management/utilization review and managed care models preferred. Supports the function of utilization management regarding pre-certification process for all intakes and consults.
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Providing case management services, life coaching, parent skill training, and make all collateral contacts as necessary. Hope For Youth has an opening as a Case Planner for the Nassau County PINS Diversion program.
$26 - $28.52 an hourExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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This well known and well established agency provides psychiatry, medication management, outpatient substance use treatment, case management, supportive housing, LGBTQ youth and youth care.
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Guidance and recommendations shall include the appropriate medical management /treatment plan, timely return to work/compliance with light duty accommodations, analysis of potential credits and/or subrogation opportunities, expense cost review, and the optimal case resolutionMonitor and maintain records for lost workdays and/or modified duty and return to work initiatives.
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This position will assist in the records review of case notes to determine MLTC plans' compliance to contracting and regulatory requirements. The incumbent will also act as a liaison with the BMLTC systems, technical assistance, and plan management units and externally with MLTC plan representatives to assure appropriate access and delivery of health services to Medicaid members receiving long term care service and supports.
$70,000 - $80,000 a yearExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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We’re seeking a hardworking, hard-playing RN (Registered Nurse) to fill a Case Management (Utilization Review) opening in San Leandro, CA. Healthcare clinicians like you want freedom, flexibility, and plenty of job options.
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The primary functions of the Associate Dean of Students are as follows: Oversee student conduct; provide student care, support, and case management; provide oversight for the campus drug and alcohol prevention programs and Biennial Review.
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Preferred Education:BSN, MSW, Case Management Certification. Job Opening Summary The Case Manager (CM) is an important member of the treatment team responsible for participating in the development of the patient's plan of care and facilitating efficient throughput, conducting utilization review, promoting appropriate utilization of resources, and identifying needs and establishing safe and appropriate discharge plans.
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One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. Through nursing, personal care, therapy, case management, and a full complement of specialized services, we bring quality care where it’s needed most.
$75,000 - $80,000 a yearExpandApply NowActive JobUpdated 6 days ago
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