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The Workers' Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and at times, attorneys to support the appropriate return to work, the provision of necessary medical services, and the evaluation of coverage under the Plan. The Nurse Case Manager reports to the Casualty Department Manager.
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Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required.
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VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Manhattan, New York. Specialty: Utilization Review. Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health.
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Genesco's employment practices will continue to be directed toward full utilization of all available human resources. Completion of all training programs leading up to Co-Manager position or equivalent training.
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Maximus provides online PASRR Level I and Level II IDD screening and online Level of Care utilization review for long-term care populations across Indiana. Description & Requirements Maximus is hiring a Clinical Review Coordinator - RN/LPN (Remote) to support the IN LCAR program.
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That includes, but not limited to their disease management physical and behavioral, medication adherence, and utilization of emergency services, hospitalizations, and avoidable complications. The Care Manager serves as member’s advocate and accompanies the member throughout their care journey.
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Experience with utilization review requirements for Medicare and Medicaid benefits. Strong knowledge of utilization review requirements for Medicaid and Medicare products. The Manager of Clinical Business Process Monitoring leads monitoring and auditing activities of clinical business processes for internal and delegated entities.
$120,000 a yearFull-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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As both a player and a coach, you will work as a CM veterinarian as needed – seeing appointments, treating cats and dogs in our Primary Pet Care (PPC) program or performing high-quality, high-volume spay/neuter (HQHVSN) for shelter/rescue animals and beloved pets.
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Chartered Financial Analyst (CFA), Financial Risk Manager (FRM), Certified Internal Auditor (CIA) or relevant securities licenses preferred. Role: Audit Manager - Global Markets Equities Location: New York, NY (Hybrid from Day 1) (Need Only Locals) Duration: Full Time Job Description : This job is responsible for overseeing assigned areas of audit work acting as an Auditor-in-Charge (AIC), and executing on the audit strategy for Lines of Business (LOBs.
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The Clinical Research Supervisor reports to the Research Administrator, Clinical Trials Manager, Research Vice Chairs and works directly with Principal Investigators within the Department of Obstetrics, Gynecology and Women's Health on the execution of reproductive health research studies, focusing on protocol development and coordination, supervising research/study assistants, and data cleaning and monitoring.
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Supervises professional and clerical employees who work with a range of functions, including but not limited to: access, pre-authorization and precertification, bed placement, coding, utilization review and denial management, care coordination collaborative treatment planning and core measures, discharge planning, clinical social work, tracking of the post-acute period and provision of disease management, and contracting internally and externally.
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The Walmart Local Marketplace team is seeking a strategic manager with expertise in end-to-end fulfillment processes to define the NorthStar vision on how our customers place and receive their orders.
$156,000 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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A Day treatment facility is looking for an RN Care Delivery Manager. Serve as a manager on call during non-operational hours of the physical sites and responsible for follow ups including follow up documentation and initiating grievances on participants/caregivers' behalf in timely manner.
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In collaboration with the Ticket Manager, develop and implement campus & community outreach programing with a focus towards increased ticket revenue. Fan Engagement & Marketing Manager. Comply with all NCAA, conference, and NJIT University rules and policies.
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Who you are: As Sales Manager / Global Education Advisor for the High School Summer Abroad team, you will be the account manager for your given territory, including the management of your enrollment coordinator(s.
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manager utilization jobs Company: Metroplus Health Plan in North Bergen, NJ
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