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Work collaboratively with the UM Director and Manager Team to develop, implement, and oversee the utilization management process to include; coordination of prior authorization needs for members engaged with care management, as well as the inpatient concurrent review process to ensure medical appropriateness, care coordination needs, and discharge planning for PacificSource patients who have been hospitalized.
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Participate in risk management, claims administration, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, nutrition service review, provider orientation, credentialing, profiling, etc.
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Certification as a CCM, CIRS, or other Case Management certifications are preferred. A cost containment background, such as utilization review or managed care is helpful. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others.
$90,940 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Collaborates with Utilization Review regarding insurance concerns and verification of acute and post-acute benefits, manage concurrent denials, and manage patient status changes including observation and code 44.
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Advanced knowledge of Case Management and Utilization Review processes, including but not limited to, InterQual and acute-care patient status regulations and guidelines. As the House Supervisor, will be responsible for collecting and analyzing data on patient admissions, transfers, and bed availability in specified clinical areas to improve patient care and maximize bed utilization.
$41.5 - $73Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Monogram's innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum.
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Written and verbal fluency in Spanish and English preferredExperienceFive (5) years of related experience or equivalent combination of education and experience required to include two (2) years of direct clinical care OR two (2) years of case management/utilization management required.
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Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.
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2 Years Utilization/Case Management experience, preferably in a Managed Care setting. To provide comprehensive utilization management and coordination of care for SRS Members.
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Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.PRIMARY PURPOSE: To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer.
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The CM I performs ongoing utilization review and acts as a liaison to the payor while assuring that cost effective treatment is provided by the team. The Case Manager I oversees the effective coordination of services and manages issues in the following main areas: admission and discharge, team conference and interdisciplinary plan of care communication, patient and family education, payor relations and total fiscal management.
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Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg experience are encouraged to apply. -Case Manager experience as well as Utilization Review experience (review medical necessity and discharge planning)FLSA Status:Non-ExemptAs a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities.
Part-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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The CCM performs ongoing utilization review and acts as a liaison to the payor while assuring that cost effective treatment is provided by the team. The Certified Case Manager (CCM) serves as a key member of the interdisciplinary team and actively manages and directs resource utilization to achieve the highest quality outcomes during a patient's rehabilitation experience.
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The Behavioral Health Case Manager is responsible for case management and utilization review of behavioral health and substance abuse services. This position provides case management services through review and evaluation of inpatient and outpatient behavioral health treatments for medical necessity, emergency status, and quality of care.
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Prefer prior experience in case management, utilization review, or discharge planning. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies.
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