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The RN Care Manager provides education to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care coordination.
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Timely investigating claims to determine first party medical coverage applicability, verification of medical damages, interpretation of medical documentation, ongoing medical management to include utilization of tools to mitigate claim severity while focusing on accurate outcomes along with ruling out potential subrogation.
$120,120 a yearFull-timeExpandApply NowActive JobUpdated 17 days ago - UpvoteDownvoteShare Job
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POSITION SUMMARY: Will engage in the negotiation, implementation, and management of regional integrated delivery networks (IDN) and hospital contracts utilizing our group purchasing organization (GPO) agreements.
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Our core focus is delivering customized medication management solutions to support healthcare organizations serving seniors and individuals with complex care needs. We're reimagining medication management and transforming care.
$44,000 a yearFull-timeExpandApply NowActive JobUpdated 29 days ago - UpvoteDownvoteShare Job
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Leads Care Management, Utilization Management and HIM activitivies in concert with Corporate Revenue Management. The healthcare system encompasses award-winning hospitals, stand-alone emergency departments, behavioral health care, skilled nursing facilities, rehabilitation services and urgent care locations.
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Internal/External Groups with which the Candidate will interface: Internal- Sunshine Health Care Management Department, Utilization Management, Medical Directors, Provider Engagement.
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Monogram’s innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum.
Full-timeExpandApply NowActive JobUpdated 24 days ago - UpvoteDownvoteShare Job
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The Care Coordinator is responsible to arrange and manage patient care as directed by the health care provider, provide self-care literature, arrange community support, and track and coordinate patient care utilization.
Full-timeExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Leading network development within the Central Florida market and cultivating key provider partner relationships in order to drive optimal performance on Stars, risk adjustment, utilization management, and overall financial performance.
Full-timeExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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As a member of the Auto Managed Care Department, the Michigan Team adjusters handle both commercial and personal lines Michigan first party no-fault (personal injury protection) and medical payments coverage claims with a focus on financial accuracy, appropriate file disposition, and adherence to statutory guidelines.
$120,120 a yearFull-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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A cost containment background, such as utilization review or managed care is helpful. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others.
$90,940 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of our health services. Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management.
Full-timeRemoteExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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Provide organizational leadership in the operational areas of care management, utilization review, appeals, quality improvement and related policy and practice initiatives in collaboration with the Corporate Medical Director(s), Senior Medical Directors, Utilization Management and the Vice President, Medical Affairs.
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Develops interdisciplinary care plan and other case management tools by participating in meetings; coordinating information and care requirements with other care providers resolving issues that could affect smooth care progression; fostering peer support; providing education to others regarding the case management process.
ExpandApply NowActive JobUpdated 17 days ago - UpvoteDownvoteShare Job
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The Case Manager is responsible for enhancing the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning.
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care utilization management jobs in Altamonte Springs, FL
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