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Ensures a defined panel of members receive the highest quality primary care within the context of a member centric plan of care, improving outcomes by impacting acute care utilization & ensuring optimal treatment for chronic disease management, in collaboration with the member's network PCP, providers & specialists.
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Determines eligibility for admission/treatment in compliance with hospital policy, utilization review criteria, and State and Federal regulations and/or guidelines. Follows all cases throughout the duration of the admission, working with Utilization Review (UR) Department every few days in Ontrac to send concurrent review clinicals.
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When naviHealth is delegated for utilization management, review referral requests that cannot be approved for continued stay and are forward to licensed physicians for review and issuance of the NOMNC when appropriate.
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The legislation was extended in 2009 under President Obama as the Ryan White Treatment Extension Act. Funds from Part A provide direct financial assistance to Eligible Metropolitan Areas (EMA) and Transitional Grant Areas (TGA) that have been the most severely affected by the HIV epidemic.
$1,180.61 - $1,439.16 a weekFull-timeExpandApply NowActive JobUpdated 4 months ago - UpvoteDownvoteShare Job
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Conducts concurrent daily chart review, investigating patient history, symptoms, clinical status, and treatment utilizing Interqual ISD criteria as a tool to determine a patient's severity of illness and the intensity of service.
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The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Humana Healthy Horizons is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.
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Experience with DRGs, HEOR, utilization management, treatment protocols, payer engagement required. This individual serves as a leader on the market access and burn teams and interfaces with peers in sales, marketing, finance, legal, medical and regulatory affairs providing the burn care franchises with field-based market access support for all key burn care facilities, trauma centers, and payers and will provide subject matter expertise to obtain favorable access and adoption into treatment protocols to broaden utilization of our novel burn care therapies.
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Beyond these concentrations, students delve into various facets of songwriting, exploring creativity, the business side of the craft, utilization of music technologies, emerging trends in the field, business strategies, and the critical examination of renowned songwriters.
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Emerson College's Office of the General Counsel (OGC) is looking for a part-time law clerk to, under attorney supervision, review and propose edits for affiliation agreements, assist with legal research, perform other legal work, and help generally support the office's operations.
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Responsible for collaborating with key leaders and stakeholders on workforce planning initiatives, organizational structure and design, and assessing the feasibility and utilization of a contingent workforce to support organization business strategy and goals.
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The Massachusetts General Hospital Heart Center's Cardiac Arrhythmia Service and Electrophysiology (EP) Lab are internationally recognized for pioneering contributions to the treatment of heart rhythm disorders, offering patients the most advanced approaches to the evaluation and treatment of cardiac arrhythmias.
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Provides ad-hoc programming support to Clinical Operations, Data Management, Statistical Programming, Biostatistics, Drug Safety, Clinical Science, Medical Writing and Drug Safety to ensure rapid access to clinical study data for data cleaning/validation, SAS listings review, TLF, dry runs, etc.
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Work with HKS Senior Gift Officer, Membership Society Coordinator, and Membership Director, in addition to Major Gifts (MG), Planned Gifts (PG), and Stewardship teams to review and update individual donor pipeline portfolios, stewardship matrix, and cultivation plan.
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Provides treatment using individual, couples, and family treatment modalities as clinically appropriate as well as therapeutic groups and Integrated Behavioral Health. Convenient location in Jamaica Plain Bilingual Spanish GENERAL SUMMARY/ OVERVIEW STATEMENT: Under the supervision of the Executive Director and Practice Manager and in collaboration with the Family Service team, the social worker is responsible for providing psychosocial assessment, diagnosis, evaluation, crisis intervention, and treatment for a diverse caseload of patients and families, addressing a broad range of psychiatric conditions.
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Meets regularly with RBT supervisor to review behavior plans, data collection and analysis. Bridgewell delivers support through community housing, day programs, outpatient treatment, recovery services, education and employment training.
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utilization review treatment jobs in Boston, MA
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