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Case Management/Utilization Review skills required: Admission Criteria, Benefits Eligibility, Care coordination, Discharge Planning, Needs Assessment/ Order DME, Plan of Care, Pre-Cert Review, Prior Authorizations, Worker’s comp case management.
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Performs admission and concurrent review to identify medical necessity, level of care and appropriateness of setting using established criteria and clinical guidelines within 24 hours of admission.
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HSCPC Case Manager - Pipeline - ( 2300034T ) Description About The HSC Health Care System The HSC Health Care System is a nonprofit organization combining the resources of a care coordination plan; (Health Services for Children with Special Needs, Inc.), pediatric specialty hospital (The HSC Pediatric Center), home health agency (HSC Home Care, LLC), and parent foundation (The HSC Foundation) to offer a comprehensive approach to caring, serving and empowering people with disabilities.
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In addition to performing functions of Document Management Technician, performs moderately complex litigation support tasks, including, for example, detailed review and analysis of case materials in a broad range of subject matters, such as financial records, health care materials, and other litigation files; detailed indexing of case files; drafting procedures for accomplishing litigation support assignments; document acquisition related tasks; and conducting database searches.
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Supervises the Case Management Staff in performing utilization review in accordance with guidelines and regulations established by the hospital board, Administration, Medical Staff, accreditation and certification agencies, and Federal and State governments.
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Collaborates with the hospital's and SNF's discharge planning personnel, utilization review department and insurance Case Managers to establish a coordinated home plan of care and facilitate safe, discharge.
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Under the direction of the VP Case Management & Continuing Care, the National Director, Central Utilization Review (UR) is responsible to oversee the development, implementation and performance management of Utilization Review services performed across all Tenet acute hospitals.
$191,568 a yearFull-timeRemoteExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies. Recent experience in case management, utilization management and/or discharge planning/home care in a high volume, acute care hospital preferred.
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Key Words: RN Travel, Travel Nurse, Contract Nurse, Agency Nurse, Travel Contract, Travel Nursing, Case Manager, Case Management, Utilization Review, Case Manager RN. The role of the case management nurse (RN) is to coordinate continuity of care for patients often as a liaison between the patient's family and healthcare organization.
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Manages the activities of hospital staff in inpatient care coordination and utilization review. The Manager-Care Management & Utilization Review, under the supervision and in collaboration with the Director, is responsible and accountable for the operational management, leadership, professional development and quality assessment and improvement activities of the department, particularly the Care Managers.
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Christiana Care includes an extensive network of outpatient services, home health care, urgent care centers, three hospitals (1,336 beds), a free-standing emergency department, a Level I trauma center, a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women’s health.
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Bachelor's degree, a minimum of five to seven years of extensive litigation or government enforcement experience, proficiency with automated litigation support technology and large, complex case document collection, review and production experience.
$137,000 a yearFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Required Licenses and Certifications Certification in Infection Control (CIC) Upon Hire (Required)Functional AccountabilitiesSurveillance - Case Identification, Reporting, and RespondingPerforms targeted surveillance defined by the Infection Control Committee in assigned patient care units/services.
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The HSC Pediatric Center (HSCPC) Case Manager oversees patients' progression through the continuum of care while at HSCPC through individualized care coordination from referral/admission through discharge.
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Works with Utilization Review staff relative to data tracking for performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process.
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review care case jobs in Silver Spring, MD
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