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The Medical Director coordinates care with the County Mental Health Plans that are responsible for the care of the population with a Serious Mental Illness (SMI), the County Alcohol and Drug Program, as well as all IEHP community and provider partners.
$115.71 - $159.1 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Utilization Review coordinator performs activities which support the Utilization Management functions. They process payor denials and retro reviews, promote optimal health care outcomes in accordance with the policies, procedures, applicable laws and contracts, philosophy, mission, and values of UofL Health, assumes responsibility and accountability for the appropriate utilization of facilities and services and serves as a resource to physicians.
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Lead Tenet Utilization Review Teams market structure and operations management to effectively support utilization review and authorization confirmation functions to promote an appropriate level of care and prevent payer denials.
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The Population Health Care Manager is responsible for delivering clinical expertise to manage health care needs of specific patient populations across the continuum of care with a goal of improving patient health outcomes and reducing unnecessary utilization and cost.
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Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
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Knowledge of Milliman/MCG guidelines or other nationally accredited utilization review criteria or standards. Conduct clinical review to ensure effective and appropriate utilization of benefits and services for prospective, concurrent and retrospective appeals within regulatory turnaround requirements for all SCFHP lines of business.
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The NP will also develop and evaluate programs related to population health care initiatives to identify opportunities for clinical interventions to reduce admissions. The ideal candidate will have a strong interest in population health and share in the goal of the program, which is to decrease patient readmittance rates.
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Syra Health offers products and services in digital health, behavioural and mental health, population health management, health education, and healthcare workforce.
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Demonstrated leadership experience in BH utilization and care management, particularly for members with Severe Mental Illness (SMI), Substance Use Disorders (SUD), co-occurring physical health issues, and dual disorders of mental health and substance abuse.
$137,800 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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These programs include but are not limited to continuing nursing education (CNE), continuing medical education (CME), graduate medical education (GME), skills lab verification, population specific competencies, and new employee orientation.
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Under the supervision of the Utilization Review Manager, this position is responsible for ensuring the delivery of outstanding customer service in the process of obtaining pre-certification approvals from insurance companies (for both inpatients and outpatients), identifying insurance and/or patient responsibility, insurance verification, admission notifications, identifying approved days, follow up required, and providing financial counseling when appropriate.
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The personnel in this position will use their knowledge of pharmacy workflows, health coaching, and insurance plans to assist in development and implementation of supports related to medication adherence/utilization and as determined by their direct supervisor or CHPA leadership.
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The DEB is the epicenter of many of UCSF's initiatives in population health, data science and informatics, health service research, health equity, and artificial intelligence.
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Participate in quality assurance and utilization review. Benefits Pay starts at $26- $30/hr Sign-on bonus Paid supervision Training Health Insurance Free CEU's PTO accrual Paid holidays Star - Loan Repayment Program.
$26 - $30 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Utilization Review Manager (URM) serves as the liaison between Great Circle treatment teams, funding sources, and external partners to obtain and review all clinical and medical services for clients at Great Circle locations.
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health education population utilization review jobs Title: educator in Norwood, Massachusetts
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