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Piper Companies is currently seeking a Remote Utilization Management Nurse for a remote opportunity within a health insurance organization. Responsibilities of the Remote Utilization Management Nurse:Responsible for performing medical reviews to assess, and coordinate quality care for patientsDetermine medical necessity utilizing MCG criteria and medical policy/contractual benefits.
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Takes appropriate and authorized actions or routes to Utilization Management or Case Management nurse. b) Receives and reviews third-party payer requests for concurrent review and notifications of denied hospital days; routes to appropriate Utilization Management nurse.
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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.
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The Utilization Review Specialist manages daily operations, which include supervising the staff performing benefit enrollments and utilization management activities. The Utilization Review Specialist review functions as the internal resource on issues related to the appropriate utilization of resources & services, coordination of care across agency and utilization review and management.
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RN Coordinator - Utilization Management & Discharge PlanningSummaCare - 1200 E Market Ave, Akron, OHPart-Time / 20 Hours / Days (2 days one wk / 3 days next wk)RemoteSummary:While taking direction from the Manager of UM, the UM Coordinator helps daily to prioritize, coordinate, and implement utilization, discharge planning, regulatory and compliance activities with the UM team.
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The MDS Coordinator supervises the Care Management Nurse, MDS Nurse. 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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Develop, implement and maintain compliance, policies and procedures regarding behavioral health utilization management functions. The Manager, BH Utilization Management will develop and facilitate processes/workflows with the team, facilities, and other vendors to ensure completion of all requests in a timely manner.
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The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned. Experience as an MDS Nurse. Registered Nurse, RN or Licensed Practical Nurse.
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Are you an experienced nurse who wants to remain clinically involved in patient care without being a bedside nurse? Ciena Healthcare is Michigan’s largest provider of skilled nursing and rehabilitation care services.
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Case management to include assessment, screening, orientation, referral, counseling, crisis response, patient education, reportinq and record keepinq and consultation with other professionals.
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Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required.
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VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Manhattan, New York. Collaborates with professionals, health plan departments such as Claims and Medical Management, and the third party administrator staff and legal, as necessary, to investigate and facilitate resolution of individual grievances and appeals.
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Currently recruiting a Registered Nurse (RN) Case Manager near Palm Springs, California , to provide care to family members of Active Duty heroes in the Wounded, Ill, and Injured Warriors (WII) under the Psychological Health Transition to Care Initiative in the Case Management/Utilization Management Division at Naval Hospital 29 Palms.
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The Utilization Review Nurse also partners with providers and facilities to assist with discharge planning. About the roleThe Utilization Review Nurse is responsible for reviewing and processing medical services requests for members of Quantum Health’s employer groups in an inpatient setting and transitions in relation.
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New role within St. Lukes Health Plan with the ability to build and shape the Utilization Management team. St. Lukes Health Plan is a wholly-owned, not-for-profit subsidiary of St. Lukes Health System, offering health insurance coverage for individuals, families and employers across south central and southwestern Idaho.
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management utilization nurse continuing jobs Company: Medical Solutions in AZ, Australia
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