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UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends. Position Summary: Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information.
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The CMO will also maintain accountability for the oversight of the Health Services division, including Pharmacy, Utilization Management, Care and Disease Management, Quality Improvement, Appeals & Grievances, Medical Policy and Provider Engagement and Clinical Transformation.
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Five years of experience in clinical setting analyzing data and performing reviews such as utilization management , quality assurance, charge capture, coding, billing and medical necessity to facilitate correct claims submission to federal and state payers required.
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Experience with Managed Care, Utilization Management, Prior Auth, and Benefits Management decision support in the Post-Acute Domain, DME, Home Health, and Wound Care. Provides clinical leadership for Utilization Management, Case Management, Disease Management, and Quality Management of Clients in cooperation with solution medical directors and the Chief Medical Officer.
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Relevant experience must be working in an HVAC engineering capacity (e.g., heating, cooling, refrigeration, duct work, SMACNA, ASHRAE, energy management controls, building management systems, mechanical codes, and indoor air quality standards), project management, blue prints, facilities design, and using AutoCAD and microstation.
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Skills in conducting claims investigation and litigation management for automobile, property, general liability, and workers' compensation. Manages the Risk Management Self-Insurance Program, covering claims involving damage to County vehicles, property, and equipment ("first party claims"); claims arising from damage or injury to citizens for automobile, general liability, property, public official's liability, law enforcement liability and environmental exposures ("third party claims") and claims arising from employee on-the-job injuries ("workers' compensation claims.
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The HMIS Manager and Data Analyst plays a leadership role in the coordination and evaluation of homeless services using the Homeless Management Information System (HMIS) and the Comparable Database for Victim Services, as required by the Continuum of Care of Homeless Services (CoC), under the leadership of the Office of Community Partnerships.
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Provide MQ support to include change management, installation, design, test, implementation and production support for data integration; project management, OS support, and departmental liaison across technical/ business unit, support procedure development, proof of concept testing, change management, and training; and software and OS upgrades, 24 x 7 support, MQ administration on Windows, Unix, Linux and mainframe.
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The RN Care Coordinator understands and applies principles of population health management to identify patients with uncontrolled chronic conditions and/or rising risk indicators and adjusts patient assignments accordingly.
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Veritas Management Group (VMG) has an opening for a Worship Leader who is responsible. Coordinates musical selections with the respective Chapel Pastor(s) and vocalist(s), Veritas Management Group (VMG) has an opening for a Worship Leader who is responsible.
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As a SIGINT Ground Coordinator on our team you will provide SIGINT ground (US Army, USMC, & SOCOM) support to the Management Team and its series of limited test events. You will also facilitate objective requirements gathering by coordinating technical exchange meetings (and other meetings as needed) with the SIGINT ground (US Army, USMC, & SOCOM) organizations, systems engineers, data modelers, and other members of the Management Team.
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Must have organizational and time management skills, with the ability to multi-taskOutdoor Enthusiast: Passion for activities such as ski/snowboard, cycling, water sports, surf/swim, skate/skateboard and more.
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Explore more InfoSec / Cybersecurity career opportunities Find even more open roles in Ethical Hacking, Pen Testing, Security Engineering, Threat Research, Vulnerability Management, Cryptography, Digital Forensics and Cyber Security in general - ordered by popularity of job title or skills, toolset and products used - below.
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Exposure to stream restoration, stormwater management, and/or shoreline protection projects. The work will focus on stream and ecological restoration projects, as well as stormwater management design, sea-level rise and sustainability.
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Administration and management of security technologies and products such as SIEM, data loss prevention, endpoint security, sandboxing, threat intelligence, pen testing and vulnerable vulnerability management, identity management.
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utilization management jobs Company: Metroplus Health Plan in Hanover, MD
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