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Leads Tenet Hospital case management operations to develop and implement centralized utilization review and authorization management services by market or region to promote an appropriate level of care and prevent payer denials.
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Click to hear Meredith tell us about a day in the life of a Utilization Review RN/Integrated Care Manager with Sentara Health. As a Utilization Review Nurse/Integrated Care Manager RN with Sentara, you work together intensely with the patients, families, and members of the medical team to provide patients with the resources they need and help prevent them from being readmitted to the hospital.
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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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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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Overall, 3-5 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in a managed care and or in a Psychiatric Hospital Inpatient and/or Outpatient experience with both case and utilization management.
$83,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Bachelor of Science in Nursing (required) An RN with a bachelor’s degree in Business, Health Care Administration or equivalent on the condition that they enroll in a BSN program within one year of employment and complete the BSN within three years of employment OR Master’s Degree in Social Work, Counseling Psychology, Clinical Psychology, Family and Marriage Therapy, Mental Health Counseling, Health Administration, or other related fields.
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The Telephonic Nurse Case Manager II is responsible for performing 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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In collaboration with the patient/family, physicians and interdisciplinary team, the Case Management Coordinator ensures patient progression through the continuum of care in an efficient and cost effective manner.
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The Care Coordinator RN performs this role to meet the individual's health needs while promoting quality of care, cost effective outcomes and by following hospital policies, standards of practice and Federal and State regulations.
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Once you master this role, you could consider the Director of Nursing, Health Services Director (Assisted Living), or other regional nursing roles with Prestige Care. 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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Minimum 2 years "telephonic" Case Management experience with a Managed Care Company preferred. "Telephonic" Nurse Case Manager II. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
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The RN Care Manager is knowledgeable of post-hospital care and services available to the patient including, but not limited to the following: Home Health, Infusion Services, Durable Medical Equipment, Palliative Care, Hospice, Outpatient Services, Transitions of Care Clinics, Transitional Care supportive programs and clinics, follow up appointments, Skilled Nursing Facilities, Rehabilitation Services and Facilities and Community-based Organizations.
$36.35 - $58.14ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Vice President of Operations for Speciality Care at Legacy Community Health will provide operational support for our Behavioral Health/Social Services, Vision, and Dental service lines.
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Case Manager/ Utilization Review/ Discharge Planning Registered Nurse - GW Hospital. The George Washington University Hospital (GW Hospital) is a 395-bed tertiary care, academic medical center located in downtown Washington, DC. Featuring a Level I Trauma Center and a Level III NICU, GW Hospital offers clinical expertise in a variety of areas including cardiac, cancer, neurosciences, women s health, and advanced surgery including robotic and minimally invasive surgery.
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Must have working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement. Description Summary: The Care Manager (CM) I works in collaboration with the patient/family, physicians and multidisciplinary team members to ensure patient progression through the continuum of care and to develop a plan of care for each assigned patient from admission through discharge.
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behavioral health continuum of care managed case manager rn utilization review jobs in Maumelle, Arkansas
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