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The BH Utilization review specialist will be a multifunction position with duties split between outpatient utilization management and compliance review. Experience in a behavioral health or other healthcare organization that reflects knowledge of Case Management/Utilization Review techniques or has certification as a Case Manager and/or Utilization Review Specialist.
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In conjunction with Hospital Departments and Committees; e.g. Legal Office, the Hospital Safety Committee, Laboratory Medicine and Performance Management colleagues, works to assess the impact of quality projects on clinical operations as well as gauge readiness and compliance for internal and external surveys, and adverse event and complaint investigations by CMS, DPH/DOH, TJC, and others as needed.
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Preferred:-Leadership experience in a utilization management clinical operations business inside a health plan or a UM/benefits management firm-Utilization management or clinical experience with post-acute care, especially home health and DME-Experience managing productivity with operational tools such as WFM software, Excel, Tableau, Smartsheet, dashboard and report-buildingFor candidates working in person or remotely in the below locations, the salary.
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Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, or Utilization Review Coordinator). The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed.
$48,000 - $52,000 a yearRemoteExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Ensure effective utilization and optimization of the Epic Tapestry system to support managed care operations and population health management. Epic certification in one of the following Tapestry modules: AP Claims and Contracts, Enrollment and Eligibility, Referrals and Authorization, Utilization Management.
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VIT needed ASAP ARRT Certification NYS DOH Rad Tech Licensure (prior to start date)[An out of state Rad Tech License is allowed as a candidate if aware that they must apply and receive the NYS license prior to their start date.
$3,039 - $3,502 a weekFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Option 3 : A two-year degree in Legal Secretary Studies, Paralegal Studies, or related field plus one (1) year of legal office experience or equivalent, such as general clerical, customer service, reception/administrative support, office management, operations, or forms and records management.
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About Conviva: Conviva Care Centers provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more.
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The Clinical Care Coordinator will play a vital role in overseeing Case Management, Utilization Review, and Infection Preventionist functions within this small hospital. Experience in Case Management, Utilization Review, and Infection Preventionist roles within a healthcare setting.
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Understand how utilization management and case management programs integrate. Utilization Review RN - remote position. Two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience.
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Experience in leadership and oversight of segment leaders and strategic direction of clinical, quality, and population health programs across care management, utilization management, quality, and value based care.
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Ensure compliance with quality standards set forth by New York State Department of Health (DOH), Federal and local regulatory laws, with guidance from the radiation safety officer and reviewing physicist.
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The Registered Nurse or LCSW Director's responsibilities include developing local care and utilization management systems, monitoring hospital department activities related to discharge planning and clinical quality improvement, and addressing resource utilization matters.
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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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Landfill gas and LFG utilization (or other biogas management) Work with multidisciplinary teams to undertake solid waste management and other infrastructure projects related to planning, design, and construction.
Full-timeExpandApply NowActive JobUpdated 10 days ago
utilization management doh jobs Company: Metroplus Health Plan
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