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2 years experience in Case Management (Care Coordination or Utilization Management) or successful completion of the Transitions in Practice (TIP) program for Care Manager.
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The Social Work Care Manager provides education to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care coordination.
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The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned. 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.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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The position’s emphasis will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care toward optimal outcomes at the appropriate level of care.
$46.96 - $74.63 an hourFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Health promotion (common physical comorbidities, self-management, use of IT, care planning, ongoing coordination) Other care management skills (transitional care management, motivational interviewing, person-centered needs assessment and care planning, etc.
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The scope of responsibility includes professional nursing care coordination practice, human resource management, educational development, research, continuous improvement, utilization management, DRG program and MGB, Brigham (BWH and BWFH) network initiatives.
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The MSR also assists in the case management of Health Service Utilization, Care Management, Radiology Benefit Manager, Transportation coordination, and the Pharmacy Department, by being the Plan's point of contact for the member and provider/pharmacies in the facilitation and coordination of services with the appropriate provider.
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As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team. Utilization review, prior authorization, Care management, Case management, interqual, ncqa, ncqa standards.
RemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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The Case Management process facilitates communication and care coordination along a continuum through effective transitional care management. The goals of Case Management include the achievement of optimal health, access to services, advocacy, appropriate utilization of resources and collaboration with post-acute care providers to ensure patient's needs are met in the community.
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Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.
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Upon successful completion of the required new employee 90-day probationary period onsite at the Population Health Building, the clinical nurse is responsible for assessing, monitoring, and providing ongoing care for patients followed by the Beebe Care Coordination episodic and longitudinal Chronic Care Management (CCM) programs.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Ensure effective utilization and optimization of the Epic Tapestry system to support managed care operations and population health management. Solid understanding of managed care processes including authorizations, referrals, care coordination, and provider network management.
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Under the direction of the Assistant Director of Utilization Management, the UM Coordinator works as a team member of the UM Department. Additionally, the UM Coordinator assists members in navigating the complex health system, facilitating care redirection, appointment scheduling, resource coordination, and resolution of any barriers related to authorization or access to care.
Full-timeExpandUpdated 7 days ago - UpvoteDownvoteShare Job
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Assists with the Coordination of all aspects of Performance Management including: setting expectations, continuing education, credentialing, performance appraisals, auditing, concurrent monitoring, utilization review, risk management and active problem identification.
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Compensation: $60-65K an hour commensurate with experienceOverview: Housing Works Health Home Care Coordination program works in partnership with medical and behavioral health providers to align services that promote access to care and enhance health outcomes for Medicaid recipients with a history or risk of over-utilization of medical and behavioral health services.
Full-timeExpandApply NowActive JobUpdated 9 days ago
utilization management care coordination jobs
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