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Christiana Care Hospital currently recruiting a Registered Nurse (RN) for our Weekend Incentive Program (WIP) with experience in Utilization Management in an Acute Care Hospital Setting.
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Preferred)Required Licenses and CertificationsRegistered Nurse (RN) license from the District of Columbia Upon Hire (Required)Specialty Certification- CCM (Preferred)Required Skills/Knowledge Knowledge of best practices as it relates to admissions processes, utilization review, discharge planning, case management, social work, care coordination and denial prevention and recovery methodologies.
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Key Words: RN Travel, Travel Nurse, Contract Nurse, Agency Nurse, Travel Contract, Travel Nursing, Case Manager, Case Management, Utilization Review, Case Manager RN.
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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. Work is administered in a variety of settings, including HMOs, community health organizations, long-term care facilities, behavioral health programs, rehabilitation centers, schools, and case management companies.
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In addition to performing functions of Document Management Technician, performs moderately complex litigation support tasks, including, for example, detailed review and analysis of case materials in a broad range of subject matters, such as financial records, health care materials, and other litigation files; detailed indexing of case files; drafting procedures for accomplishing litigation support assignments; document acquisition related tasks; and conducting database searches.
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Recent acute care, case management, or home health experience preferred. Two (2) years of utilization review experience required. Reviewing documentation to support the written notice to include review of clinical documentation by the appropriate professional.
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The Field- Based Remote Behavioral Health Case Worker develops a plan of care through shared decision-making with the Member/caregiver and in collaboration with providers and other care team members to improve the Member's health status and compliance with treatment plans and promote self-management.
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FTI Technology utilizes modern review platforms for native document review and case management. Our practice primarily provides professional consulting services to corporations and law firms for coordinating document review and production using Relativity and/or Nuix Discover.
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Collaborates with the UM Compliance Team to address on-going educational needs related to written notice management. Knowledge of managed care preferred. The Correspondence Compliance Coordinator is responsible for the generation of UM required written notices to Kaiser Permanente members and providers.
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Supervises the Case Management Staff in performing utilization review in accordance with guidelines and regulations established by the hospital board, Administration, Medical Staff, accreditation and certification agencies, and Federal and State governments.
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The Utilization Management Nurse will work closely with ED providers to review medical necessity and collaborate for discharge planning, as appropriate. The Utilization Management Nurse will be responsible for ensuring the delivery of efficient and effective health care while evaluating the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provision of the applicable health benefits plan.
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Case Management/Utilization Review skills required: Admission Criteria, Benefits Eligibility, Care coordination, Discharge Planning, Needs Assessment/ Order DME, Plan of Care, Pre-Cert Review, Prior Authorizations, Worker’s comp case management.
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Manages the activities of RN Case Managers for in inpatient care coordination and utilization review. The RN Manager is responsible and accountable for the operational management, leadership, professional development and quality assessment and improvement activities of the department, particularly the Care Managers.
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Creates, coordinates, implements and manages organizational tracking systems for large and complex document collection, review, analysis, and case management both on and off-site.
$137,000 a yearTemporaryExpandApply NowActive JobUpdated 17 days ago - UpvoteDownvoteShare Job
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Track and review program participants rental obligation payment data, and act as a liaison between participants, Greater Washington Urban League, and landlord/property management to resolve discrepancies.
$55,000 a yearFull-timeExpandApply NowActive JobUpdated 21 days ago
review care case management jobs in Washington, DC
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