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Job Summary: The Manager of Case Management is responsible for the day-to-day operations of Case Management Program including utilization review, discharge planning and inpatient denials management.
$90,000 - $130,000ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Responsibilities Provide health care services regarding admissions, case management, discharge planning and utilization review. May prepare statistical analysis and utilization review reports as necessary.
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This requirement will be lifted for LBH candidates employed as a Utilization Review Nurse, Clinical Care Coordinator, Patient Care Integrator or RN Case Manager. The Care Manger strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimize denials of payment among a patient population with complex health needs.
$15,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Researches criteria within utilization computer system in order to monitor inpatient level of care and to facilitate and assist doctor-to-doctor and peer-to-peer review between Hospital and health plan.
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Hospital: Ascension St. Agnes Location: Baltimore, MD Seeking experienced Utilization Review nurse for weekend focused OBS review work. Responsibilities Provide health care services regarding admission, case management, discharge planning and utilization review.
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Provide health care services regarding admissions, case management, discharge planning and utilization review. Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
Starting at $69,555.2 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials.
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Experience managing denials and appeals of all payer cases in a timely and organized manner. MSW accepted in lieu of registered nurse (RN) licensure. Required - Current registered nurse (RN) license in state of practice.
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Participate in Revenue Cycle, Denials, Billing Compliance and Utilization Review Committees/meetings. The Utilization Review RN Care Manager (CM) focuses on ensuring accurate and timely utilization review of the hospital medical surgical and maternal child health inpatient population.
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Bachelor's degree in Nursing, Healthcare Administration, or another relevant field A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan An active CA Registered Nurse license Current BCLS (AHA) certificate upon hire and maintain current Analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process.
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The utilization review nurse manages all activities related to the monitoring, interpreting, and appealing of concurrent clinical denials received from third-party payers and ensures accuracy in patient billing.
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The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes approval determinations and appropriate exceptions, coordinating with Medical Directors on denials, completing inpatient level of care reviews, post-acute care initial and concurrent reviews for acute and subacute rehabilitation, transportation and DME requests.
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Licensed Registered Nurse in the state of CT with 3+ years of inpatient case management, utilization review, clinical documentation improvement, and some quality assurance / improvement.
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The Nurse Auditor reviews medical records for hospital clients to review including denials, disallowed charges and more for the facility. Nurse Auditors perform medical bill and defense audits, and review grievances and claim denials.
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Responsible for managing all deferrals and or denials by conducting a comprehensive review of clinical documentation, clinical criteria/guideline, policy, and or EOC/benefit policy. We are currently seeking a highly motivated Denial Review Nurse.
$30 - $45 an hourFull-timeExpandApply NowActive JobUpdated Today
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