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Piper Companies is currently seeking a Remote Utilization Management Nurse for a remote opportunity within a health insurance organization. Responsibilities of the Remote Utilization Management Nurse:Responsible for performing medical reviews to assess, and coordinate quality care for patientsDetermine medical necessity utilizing MCG criteria and medical policy/contractual benefits.
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In conjunction with the Health System AVP for Care Coordination, this position provides daily operational oversight, management and leadership for staff of the Case Management Department whose activities are associated with the continuum of care, clinical cost reduction, utilization management, care transitions, population management, quality, performance improvement, reimbursement and discharge planning.
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This role focuses on improving the health status and connection to resources, preventive care, hospital follow-up, and ongoing healthcare for individuals with chronic health conditions as well as addressing frequent hospital and emergency department utilization, and medical, behavioral health, and psychosocial needs by performing care management and care coordination functions in a variety of settings that include a patient’s home, community, and clinic.
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Transitional Care Management / care transition support inclusive of functions of placement into the right setting of care (e.g., skilled nursing, assisted living, home with caregiver support) Maintains timely documentation of all care management activity in Maestro, and other documentation systems relevant to the position.
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The VP – Project Management will oversee all planning, scheduling, and budgets from preconstruction to completion across the EPC portfolio. Rapidly growing solar utility EPC is actively recruiting a VP – Project Management to join the team.
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Primary duties of the Trash Collector include: - Operating garbage trucks - Collecting and dumping trash receptacles - Following route assignments as directed Waste Management offers an excellent benefits package that includes medical, dental, vision, life, 401(k) savings and more.
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Integrate case management (CM) with utilization management (UM) and disease management as needed. Facilitate command cost containment through proper utilization of available resources and timely assessment of patient response to the case management program.
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Transitional care management. Certain components of Tailored Care Management will always be led by a care manager. Ability to work as a team member and under the direction of the Care Manager and the Care Management department.
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Disease management and chronic disease support •Timely completion of clinical assessment and patient-centered care plan development, facilitation, and implementation •Transitional Care Management / care transition support inclusive of functions of placement into the right setting of care (e.g., skilled nursing, assisted living, home with caregiver support.
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At Biogen, the Data Management and Analytics (DMA) department plays a pivotal role in the compiling, processing, and utilization of data to provide valuable insights that guide decision-making.
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Skills: RN, LPN, registered nurse, ER, Inpatient, emergency room, case management, CM, Care Management, Case Manager, utilization management, UM, MCG, Medical Necessity. The Remote Utilization Management Nurse will be serving as an essential bridge between health care and medical coverage.
$76,000 - $79,000 a yearFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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This position will support the BT Risk Manager in the management and administration of the Cyber/Risk Management program and Governance Risk and Compliance (GRC) processes and tools. The Business Technology (BT) Sr. Cyber Risk Analyst is responsible for risk identification and management across the BT department and the overall American Heart Association organization.
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Additional management degree and lean principles training is preferable but not required. Duke University Health System Seeks Applicants for Chief Medical Officer, Duke Health Integrated Practice.
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Oversee laboratory operations for all QC laboratories including equipment maintenance, reagent and inventory management, sample management including retains, and stability program management.
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Civil utility and site design (water, sanitary sewer, storm drain, HGL modeling, fire flow design, and storm water management and dentention) and coordination with typical mechanical utilities (gas, steam, chilled water, high voltage, emergency power, communications duct banks.
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psychological utilization management jobs Company: Kaiser Permanente in Durham, NC
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