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About Conviva: Conviva Care Centers provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more.
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Preferred:-Leadership experience in a utilization management clinical operations business inside a health plan or a UM/benefits management firm-Utilization management or clinical experience with post-acute care, especially home health and DME-Experience managing productivity with operational tools such as WFM software, Excel, Tableau, Smartsheet, dashboard and report-buildingFor candidates working in person or remotely in the below locations, the salary.
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The BH Utilization review specialist will be a multifunction position with duties split between outpatient utilization management and compliance review. Experience in a behavioral health or other healthcare organization that reflects knowledge of Case Management/Utilization Review techniques or has certification as a Case Manager and/or Utilization Review Specialist.
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Experience in leadership and oversight of segment leaders and strategic direction of clinical, quality, and population health programs across care management, utilization management, quality, and value based care.
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The Clinical Care Coordinator will play a vital role in overseeing Case Management, Utilization Review, and Infection Preventionist functions within this small hospital. Experience in Case Management, Utilization Review, and Infection Preventionist roles within a healthcare setting.
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Ensure effective utilization and optimization of the Epic Tapestry system to support managed care operations and population health management. Support system enhancements to align with population health management and value-based care initiatives.
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Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, or Utilization Review Coordinator). Job Overview: The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies.
$48,000 - $52,000 a yearRemoteExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Must have working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement. The CM is responsible for identifying, initiating, and managing optimal patient flow/throughput to enhance continuity of care, smooth and safe transitions, patient satisfaction, patient safety, and length of stay management.
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The Registered Nurse or LCSW Director's responsibilities include developing local care and utilization management systems, monitoring hospital department activities related to discharge planning and clinical quality improvement, and addressing resource utilization matters.
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The care management system provides critical, core health plan functionality including utilization management, transportation authorization, care management, population health, appeals and grievances, analytics and reporting.
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Minimum of six (6) years in a managed care operations, working with one or more of the following areas: Utilization Management, Claims, Pharmacy Operations, Compliance, FDR oversight activities, Quality Management, Care Management, and/or Grievances and Appeals.
$38.37 - $48.93 an hourFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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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 organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology.
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Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care. Promotes and facilitates effective management of hospital resources from admission to discharge, collaborating with the assigned clinical team to identify patient most likely to benefit from care coordination services to include assessing patients’ risk factors and the need for care coordination, clinical utilization management and the transition to the next appropriate level of care.
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SBELIH provides care to 25,000 year-round residents and expanding to 60,000 summer residents with comprehensive healthcare solutions, including behavioral health, medical-surgical, orthopedics and general surgery, wound care, interventional pain management and GI, advanced ambulatory care, diagnostic, and physical therapy services.
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