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Minimum of six (6) years in a managed care operations, working with one or more of the following areas: Utilization Management, Claims, Pharmacy Operations, Compliance, FDR oversight activities, Quality Management, Care Management, and/or Grievances and Appeals.
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Participate in leadership team by actively contributing in decision making, grievance follow up, building and company-wide initiatives and attending leadership team meetings such as stand up, Managing Acute Care Conditions (MACC), Nutrition at Risk (NAR), Utilization Review (UR), Quality Assurance Performance Improvement (QAPI) and other meetings as required.
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Keep current on federal and state regulatory policies related to utilization management and care coordination (CMS guidelines, Health Plan policies, and benefits) Being a pioneer in post-acute management and care transitions with 19 years of experience, naviHealth is uniquely positioned to manage patients, improve clinical and financial outcomes, and share risk with payors and providers.
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Strong analytical, data management and PC skills Current working knowledge of discharge planning, utilization management, case management, performance improvement, disease or population management and managed care reimbursement.
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Requires dedicated and focused customer facing support through the Reimbursement Management Team. The Field Reimbursement Manager is a critical front-line member of the Regeneron Commercial and Field Reimbursement Management team.
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Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator.
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Payer Formularies and restrictive Utilization Management Criteria including: Prior Authorization Processes, Step Edits, Appeals, detailed Clinical Documentation, Peer to Peer reviews etc.
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The Field Reimbursement Management reports to the District Manager of Field Market Access. The primary purpose of this role is to support Health Care Practitioner offices in obtaining appropriate access to Regeneron products for patients.
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Expert DevSecOps/DevOps experience with setup, management, and utilization of software factory/tools pipeline for development, continuous integration and delivery of software products. The successful candidate will have a proven track record designing, implementing, and driving efficient utilization of common DevSecOps/software factory tool pipelines for an Agile software development team.
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The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology.
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Tree and Turf Care is seeking a Full Time Lawn Care Manager in Alpharetta who will oversee our dedicated team and ensure our clients' landscapes are thriving. If you're ready to showcase your skills and knowledge in lawn care management, join us at Got Lawn.
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Lead a team of security engineers for delivery of Cybersecurity project management, continuous diagnostics and mitigation, threat mitigation and incident response, security architecture support, critical infrastructure protection, patch management, vulnerability management, risk management, information assurance, penetration testing, cybersecurity services, and Security Assessment and Authorization (SA&A) documentation.
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Demonstrates the ability to select, utilize and document appropriate Evidence Based Practices including CBT, DBT, MI treatment modalities based on clinical guidelines, medical necessity criteria and utilization management principles.
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Key Words: RN Travel, Travel Nurse, Contract Nurse, Agency Nurse, Travel Contract, Travel Nursing, Case Manager, Case Management, Utilization Review, Case Manager RN. The role of the case management nurse (RN) is to coordinate continuity of care for patients often as a liaison between the patients family and healthcare organization.
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Overall management responsibility for the NH team members consisting of NH. ), or ISR aircraft (i.e. U-2, RQ-1, RQ-4, MQ-9, RQ-170), or Air Battle Management (I.e. E-2, E-3, E-8, AOC, JTAC, CCT, etc.
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utilization management care team jobs Company: Metroplus Health Plan
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