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6 years’ leadership / management experience; 4 years’ experience in medical record review, case management, utilization management, managed care, Home Health, QA Review, HEDIS review; 4 years’ experience with healthcare payment and coding methodologies (i.e., ICD-10, CPT, DRG and HCC coding.
$236,290 a yearFull-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.
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Focus in either Utilization Management/Care Management/Denials Management and expected to be cross trained to allow critical coverage for all areas as needed, including but not limited to: UM case review, peer-to-peer review for medical necessity, appeal writing/supervision.
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Identifies when variances occur in anticipated plan of care, tracks for process improvement, and refers to CMO or PA or Third Party Reviewer for peer review as needed. Interfaces closely with Social Worker, Homecare Coordinator, Ambulatory Care Case Manager, Disease Manager, and Utilization Reviewer to ensure seamless and timely delivery of services and avoid unnecessary delays in discharge.
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Position : Travel Registered Nurse Location : Memphis, Tennessee Schedule : Day 5x8-Hour (08:00 - 16:30) Duration : 13-Week Contract Unit : Utilization Review What You'll Do : As a Travel Registered Nurse, you will perform and participate as part of the Case Management team to support a collaborative effort to facilitate quality patient care.
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The role of the case management nurse (RN) is to coordinate continuity of care for patients often as a liaison between the patient’s family and healthcare organization.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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This role involves data analysis, report creation, system administration, and acting as the primary point of contact for the third-party hotline and case management system vendor.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
$44.53 an hourFull-timeExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Accountable for the overall integration, management, and implementation of the Medicare Risk Adjustment Program across Alpine. VP of Risk Adjustment is responsible for the overall management and implementation of various initiatives including, but not limited to, Risk Adjustment Programs.
$236,290 a yearFull-timeExpandApply NowActive JobUpdated 22 days ago - UpvoteDownvoteShare Job
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Has knowledge of community health concepts, principles of ambulatory clinical nursing care, case management and care coordination. Demonstrate competency in a variety of therapeutic/diagnostic interventions including but not limited to IV's, incision/wound care, medication administration, catheterization, and specimen collections.
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Conducts comprehensive evaluations of referred members’ needs/eligibility using care management tools and recommends an approach to case resolution. The Care Manager Specialist is a member of the Care Team. The Care Manager Specialist is responsible for the care management of members that are enrolled in the Dual Special Needs Plan and have limited health conditions.
$40.9 an hourFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Complies with managed care standards regarding regular utilization review of all assigned cases in order to meet all licensing requirements for residential treatment of adolescent populations.
$60,400 a yearFull-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Performs a variety of case management functions, including but not limited to, coordinating admissions from and transfers to referring facilities and providers, utilization review, discharge planning, transportation coordination and care coordination in a variety of clinical settings.
Full-timeExpandApply NowActive JobUpdated 25 days ago - UpvoteDownvoteShare Job
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Participates in the case management of peer review of client records and provides consultation to case managers and other staff members regarding medical and nursing issues.
$54 an hourFull-timeExpandApply NowActive JobUpdated 29 days ago - UpvoteDownvoteShare Job
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Three (3) years of experience in epidemiology, data analysis for communicable disease prevention, investigation and public health in prison/correctional or shelter setting operations to implement appropriate and effective disease control measures in response to disease cases and outbreaks AND Graduation from an accredited college or university in public health, health education, health care management or in a closely related field.
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review of care case management jobs in Aurora, CO
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