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Unless expressly allowed by state or federal law or regulation a must be located in a state or territory of the United States when conducting a utilization review or an appeals consideration and cannot be located on a US military base, vessel, or any embassy located in or outside of the US.
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Experience in managed care, specialty drugs, care management and utilization review. Job Posting Title Infusion Referral Nurse- REMOTE Job Description Summary Under supervision, is responsible for performing referral services to support independent physician offices with maintaining member drug infusions in office or to help offices locate a lower cost alternative treatment site (e.g., home infusion) for drug infusion services versus the hospital outpatient facility.
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Strong cost containment background, such as utilization review or managed care helpful. Prepare submission of MSA proposal to CMS for review and approval. Assess, review and summarize medical records in a clear, concise manner.
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Maintains records of spiritual care services utilization and related activities for quality assurance, program development, and policies and procedures review and revision. The Hospice Chaplain is responsible for the provision of spiritual care services to patients and families/caregivers of St. Croix Hospice, either directly or through coordination of care with other spiritual counselors.
Full-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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We are seeking a dedicated Travel RN specializing in Utilization Review to join our team. This role integrates and coordinates various aspects of service delivery, care facilitation, pay or authorizations, service access, discharge and post-discharge activities, and utilization review.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Influence, collaborate and negotiate with providers in an open, direct, and supportive manner to resolve conflicts, utilization review issues and alternative treatment setting options. Provide utilization management review and support to members and health care providers.
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Carries out hospital programs and principles of utilization review in compliance with hospital policies and external regulatory agencies Peer Review Organization (PRO), The Joint Commission (TJC, and multiple payer defined criteria for eligibility.
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Including case and disease management, utilization management and review, and medication therapy management. The Community Health Outreach Specialist is responsible for engaging with hard to reach, high acuity patients and helping them.
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Case Management, Utilization Review. Trinity Health FirstChoice is seeking a travel nurse RN Case Management Manager for a travel nursing job in Des Moines, Iowa. Trinity Health is a leading not-for-profit Catholic health system with 92 hospitals and hundreds of primary, specialty and continuing care centers across the United States.
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Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid. Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, and acute inpatient rehabilitation.
$274,400 a yearFull-timeExpandUpdated Today - UpvoteDownvoteShare Job
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Attends, actively participates, and provides MDS, QM, and Reimbursement expertise at the following meetings: Daily Clinical, Weekly Resident at Risk, Weekly Utilization Review and Daily Stand up.
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Review utilization management (PA) criteria and clinical policy revisions/reviews. Participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions.
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Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.
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Providing medical direction to the support services review process and ensuring quality of utilization review determinations, including appeals. May function as Medical Director for select health plans or regions, assuming overall accountability for utilization management.
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Automated deployment/implementation of various vendor software to desktops Documenting processes and assuring continuous review of processes for maintenance and process improvement Manage and implement monthly and immediate (zero-day) patches for corporate end user devices running Windows Desktop 10/11 using System Center as well as vendor-based patching mechanisms.
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utilization review jobs in Johnston, IA
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