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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.
$44,200 - $60,900 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Field Community Health Worker, (Care Management Support Professional 1), contributes to the administration of Care Management and Utilization Management. The Field Community Health Worker, (Care Management Support Professional 1), builds visibility and credibility of Humana's products and services throughout the community via chats, posts, and interactions.
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Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Full-timeExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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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.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Director Care Coordination- Major Responsibilities Criteria A: Establishes and coordinates communication with all Utilization Regulatory Agencies i.e. Qualidigm, NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials.
ExpandApply NowActive JobUpdated 13 days ago - UpvoteDownvoteShare Job
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Our Utilization Management Appeals Nurse – LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations. Acentra is currently looking for a Utilization Management Appeals Nurse – LPN/RN to join our growing team.
$24 - $35 an hourFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Manage the operations and activities of the Care Coordination Department including discharge planning, utilization management and high-risk case management. Reviews and edits Managed Care Contract Language relating to Utilization Management Issues.
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Master's Degree in Nursing or Health Management desired but not required. Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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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.
$33 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Collaborates with staff/departments, including, but not limited to: Executive Management, Resource Management, Medical Records, Patient Administration, Group Practice Managers, Health Care Integrators, Coders/Coding Auditors, Population Health Nurse Consultants, Medical Management, Referral Management, TRICARE Operations, patient care teams, Quality Improvement, and the Managed Care Support Contractors.
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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). Utilization Review Specialist/Behavioral Health Substance Abuse.
RemoteExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Interact with insurance companies for pre-certification and utilization management. ounselor, social worker, marrage and family therapist, inpatient, counseling, therapy, LMHC, registered, behavioral health professional, LPCC, LPC, LMFT, MFT, QMHA,licensed.
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Ensure effective utilization and optimization of the Epic Tapestry system to support managed care operations and population health management. Support system enhancements to align with population health management and value-based care initiatives.
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The Utilization Management Nurse oversees the care of a participant as they move from one health care facility, such as a hospital or nursing home, to another facility or their home.
$79,040 a yearFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Piper Companies is currently seeking a Remote Utilization Management Nurse for a remote opportunity within a health insurance organization. The Remote Utilization Management Nursewill be serving as an essential bridge between health care and medical coverage.
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utilization management health jobs Company: Metroplus Health Plan
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