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Perform initial prior authorization review of post-acute care services applying guideline criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination.
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Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health.
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Tracks the status of plan in the review process by entering data in Accela and other software. Enforce City of Atlanta Stream Bank Buffer requirements, review for and enforce State of Georgia Stream Bank Buffer requirements, coordinate with other agencies as necessary, e.g. Georgia Department of Natural Resources, Georgia Soil and Water Conservation District.
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Interim Healthcare of Topeka, Manhattan, and Lawrence is the only agency in these areas that offers the full continuum of care - which consists of Home Health, Hospice, Private Duty, and Staffing Services.
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The CMO will work collaboratively in these activities with ongoing UCS initiatives under the aegis of UCS Regional CMO. The Plan CMO will be the outward face to State regulators based upon Contract, and direction of Plan President and C&S CMOInnovation - The Plan CMO leads the clinical interface with care providers and UHC network management colleagues in efforts to transform the health system.
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By bringing together the scope and reach of Jefferson Health – a top integrated health care system with a vast array of home health and hospice caregivers and volunteers– and the extensive management capabilities, operating platform, and clinical experience of BAYADA – a leading not-for-profit home health care provider, Jefferson Health at Home by BAYADA will strengthen and extend the continuum of care in the region.
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The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
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Nationally ranked Riley Children's Health is seeking a Pediatric Palliative Care physician to deliver compassionate care across the continuum in the inpatient, outpatient, and home settings for Indiana children and families.
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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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External Candidates eligible for a $10,000.00 Commitment Bonus paid over 2 years General Description of the Job Class The Population Health Care Manager is responsible for delivering clinical expertise to manage health care needs of specific patient populations across the continuum of care with a goal of improving patient health outcomes and reducing unnecessary utilization and cost.
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PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations.
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Experience with LTC service offerings and competitive landscape of the LTC pharmacy space. Reporting to the Division Vice President, this position collaborates across teams to implement growth initiatives, execute sales strategies, and contribute to PharMerica's overall revenue plan.
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The FCRO has been given the authority and responsibility for reviewing cases of children in out-of-home care through Department of Health and Human Services, Juvenile Probation, or on a Trial Home Visit through DHHS, and making required recommendations regarding the plan for the child’s future (known as the permanency plan), services for the child and family, and the appropriateness and safety of the child’s placement (foster home, group home, detention facility, or specialized facility.
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PharMerica isone of the nation'slargest pharmacy companies. At least 2 years of experience managing pipeline forecasting or account management in the senior living or LTC space. Works collaboratively with the Business Development Associate and Associate Vice Presidents to identify and target net new customers and grow existing books of business.
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Bachelor's Degree and 2 years of experience in a direct B2B sales position. Excellent verbal and written communication skills, CRM proficiency, sales acumen, and a track record of successful client management.
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review continuum of care health plan jobs Company: Kaiser
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