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You will oversee utilization management process including verification of insurance coverage, pre-authorization, resource management and overall management of patients within the continued stay criteria.
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By leading market level projects and strategies for provider engagement, this position will drive optimal performance on quality, risk adjustment, utilization management, financial performance, and membership growth.
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Also responsible for marketing and enrollment growth, utilization management, network development, and all aspects of financial performance. cardiology, bariatric surgery, oncology, endocrinology, primary care, allergy, immunology & rheumatology, pulmonology, elderly services, infectious diseases, hematology, women's health, nursing, gynecology, labor and delivery, neurology, rehabilitation, mental health servies, behavioral health services, neurosurgery, physical therapy, and orthopaedics.
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UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends. Position Summary: Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information.
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Minimum of five years experience in the mental health and substance abuse field required; experience with all target populations and direct experience performing benefits and/or utilization management in a managed care setting preferred.
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MUST have experience working within the Palantir Foundry platform using Python for data management, analytics and modeling, and experience building dynamic visualization dashboards and graphics.
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With TPMG partner, directs development and implementation of quality and utilization standards across the continuum of care to ensure coordinated plans of treatment, patient focused delivery of services and cost effective utilization of necessary services.
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Job Description - Clinical Documentation Coordinator - Utilization Review Management (Temple Physicians, Inc./40 hours days) (235095) Go to the main content section. With convenient locations, leading edge care, and staff who feel more like family, careers with Temple Physicians are second to none.
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Three years recent clinical experience in Lung/ECMO/Transplant and experience in case management/utilization preferred. Whether you choose to focus on bedside care, a leadership or C-suite role, shape business and operational outcomes, or work to deliver clinical excellence behind the scenes in data science, case management or transfer centers.
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MELE’s services include national security, intelligence, law enforcement and emergency response training, IT/cybersecurity, facility management and engineering, CBRNE defense and nuclear security, and mission and program support.
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Unlike traditional congregatecare settings, our approach involves placing unaccompanied children infoster homes while diligently searching for and assessing potentialsponsors identified in the US. During their stay with us, we providemedical care, case management, engaging life skills classes, andessential mental health services.
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JOB SUMMARYThe RN Utilization Review coordinates care for OPIS patients who are high cost, complex, and at risk. NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.
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As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics.
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The Field Community Health Worker, (Care Management Support Professional 1), contributes to the administration of Care Management and Utilization Management. Community Health Worker collaborate with Case Managers, (CMs), and Utilization Management, (UM), Nurses to address co-occurring physical health, behavioral health, and social factors affecting members.
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Leader the charge in adopting and refining data management practices, utilizing CAD/CAFM systems to maintain accurate, actionable space utilization insights. The Metropolitan Transportation Authority (MTA) is seeking an innovative Deputy Director, Occupancy Management to support real estate operations for the largest Transportation Authority in North America.
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utilization management care jobs Company: Metroplus Health Plan
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