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The Utilization Management Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS. The Utilization Management Nurse III is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services.
$33.3 - $44.49 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Licensed independent Behavioral Health clinician (i.e. LCSW, LCPC, LMFT, LPCC, LPAT, LPC) with addiction Counselor licensure (LAC) or a Registered Nurse (RN) with unrestricted state license with psychiatric specialty, and addiction Counselor licensure.
$29.1 - $62.31Full-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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The RN Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services CMS Inpatient List.
$31.7 - $42.35 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Assistant General Counsel supports and reports to the Chief Legal Officer and provides legal advice on a wide variety of matters related to Community's Medicare, Medicaid and Marketplace programs and operations including contracting, quality, utilization management, network management, privacy and security, litigation, fraud, waste and abuse, and contractual and regulatory compliance.
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Utilization Review Specialist BenefitsKnowledge and skills at a level normally acquired through the completion of a Bachelor's Degree in human service or behavioral health with two (2) years experience in the field of chemical dependency, or adolescent treatment or equivalent experience and training in behavioral health field.
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Expertise in Medicare risk adjustment, STARS, Medicaid matters, provider contracting, and behavioral health parity. A law firm in Los Angeles, CA is seeking a Corporate Health Plan Associate Attorney to provide strategic legal counsel to dynamic healthcare clients.
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NYC Health + Hospitals Office of Behavioral Health seeks a visionary and dynamic leader to join our Office of Behavioral Health Care Management Strategies. Proven leadership in healthcare management, particularly in behavioral health settings.
$120,000Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The analyst monitors and reviews existing and new Center for Medicare and Medicaid Innovation (CMMI) Government Programs whether for the hospital system, the ambulatory providers, or the CIN, to understand the risk components and partners with the Chief Population Health and Growth officer and interdisciplinary team to assess feasibility and requirements for participation.
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Strong knowledge of and/or experience with government programs regulatory, operational, financial, and clinical requirements for the delivery of health insurance and managed care products and services, including Medicare, Medicaid, MMP, LTSS, SNP, Duals, CHIP and behavioral health, as well as the associated and relevant federal, state and local regulatory entities.
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Manipulates and extracts Medicare, Medicaid, and other healthcare claims data stored in Cloud environment using appropriate software such as SAS, Snowflake, Python, R, SQL, and other software as appropriate for the task.
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Experience in health care, health plans, Covered California, Medicaid Managed Care Plans (MCPs), Medicare Advantage, Medicare Part D, Special Needs Plans (SNPs), and/or Medicare-Medicaid Plans (MMPs)/Cal MediConnect.
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Strong understanding of federal and state regulatory bodies, government payers including CMS (Medicare Parts A, B, D, and Medicare Advantage), Medicaid (Medicaid FFS and Medicaid health plans), HRSA (340B), and state healthcare programs, as well as commercial payers.
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The position also requires Qualified Mental Health Associate (QMHA), as the position is located in the Multnomah County Community Health Center, which is a covered Federally Qualified Health Center (FQHC) under the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services.
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In depth knowledge of acute care Case Management to include medical necessity, utilization review, LOS management, readmission reduction, denials management and effective transitions of care impacting revenue cycle.
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Ensures compliance with all relevant regulations, including those set forth by the Indian Health Service (IHS), Centers for Medicare & Medicaid Services (CMS), and other governing bodies.
$289,500 - $350,000 a yearFull-timeExpandApply NowActive JobUpdated Today
medicare medicaid utilization management behavioral health jobs Company: Jubilee Medical Services
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