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The Utilization Management Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS. The Utilization Management Nurse III is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services.
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As a Case Management Coordinator, you will facilitate efficient Care Management services, monitor compliance with assigned responsibilities, complete daily/weekly tasks, and coordinate with patient financial services.
$18.88 - $28.8 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Operations, Supply Chain, Sales and Marketing) Utilization of a data-driven approach towards decision making, leveraging datasets spanning consumer insights, market data, service levels, sales data, and more.
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Keep current on federal and state regulatory policies related to utilization management and care coordination (CMS guidelines, Health Plan policies, and benefits) + 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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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.
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Focus Staff is seeking a Travel Utilization Review RN Registered Nurse to review and audit behind the scenes to maximize the quality and cost efficiency of health care services. Utilization RN – Utilization Review RN – Travel Utilization Review RN, Part-Time, Contract, Travel, Temporary, 13 Weeks, Temp. Tier5, Travel Utilization Review RN Registered Nurse.
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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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Experience in quality, care coordination, utilization management in an inpatient, ACO or FQHC environment. Administrative practices and procedures including but not limited to quality assessment and improvement, care coordination, utilization review, peer review, credentialing and risk management.
$118.44 - $165.82 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Current working knowledge of discharge planning, utilization management, case management, performance improvement, disease or population management and managed care reimbursement.
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Working knowledge in areas of patient registration, billing, accounts receivable (AR) and cash management requirements, managed care contractual terms and requirements, health insurance practices, industry regulatory requirements, business office operations, AR and financial reporting technology, wage and hour regulations, basic accounting, and industry standards for healthcare revenue resolution management practices.
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Experience in utilization management, case management, discharge planning or other cost/quality management program preferred. -Completes Utilization Management and Quality Screening for assigned patients.
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The Utilization Review coordinator performs activities which support the Utilization Management functions. They are responsible for the delivery of the Utilization Management process including but not limited to: making clinical recommendations regarding medical necessity for admission and continues stay, screens patients for client specific guidelines regarding insurance, Medicare and/or Medicaid guidelines, send payor specific Notice of Admission and continued stay reviews.
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The Jira/ServiceNow Administrator will involve managing, configuring, and maintaining the application platforms to support the organization's project management and ServiceNow environments, issue tracking, and workflow processes, support IT service management (ITSM) and other business processes within the organization.
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The Utilization Review Specialist review functions as the internal resource on issues related to the appropriate utilization of resources & services, coordination of care across agency and utilization review and management.
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Will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to setup systems to ensure accuracy of payments processing. Work with provider reimbursement tools, collaborate with Claims Operations, Utilization Management, and Network Management to setup pricing methodologies.
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utilization management jobs Title: care coordinator Company: Unitedhealth Group in Jean, Nevada
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