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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.
$93,000 a yearPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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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. About the program: The State of Indiana Family and Social Services Administration (FSSA) has partnered with Maximus to manage the Indiana Level of Care Assessment Representative (LCAR) Services.
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As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics.
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Preferred Qualifications: Minimum two (2) years of RN experience in utilization review, ambulatory case management, care coordination or disease management. The Liaison Nurse collects data and provides input to leadership regarding issues or concerns related to utilization, cost, quality, service and care delivery to patients.
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Collaborate with an inter-professional team, including but limited to; physicians, nurses, nutrition, physical therapy and select wound care team members, to ensure smooth day-to-day operations within respective team, ensure high quality care, proper hand-off communication and effective and efficient resource utilization.
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REQUIREMENTS FOR MEDICAL DIRECTOR – PHYSIATRIST: Board certified by American Board of Physical Medicine and Rehabilitation ( ABPMR ) Active Unrestricted MD or DO License Required NJ License Required 5+ years of clinical experience with managing & Identifying data/trends Utilization management experience focusing on PM&R cases Proficiency working with Tableau or similar software required Proficiency also required working with a Windows based environment including MS Office products.
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The role integrates and coordinates utilization management, care coordination, discharge planning functions and performance improvement activities for all care managers. The Supervisor, Care Management is accountable for oversight of the department's designated team member caseloads and plans effectively in order to meet staffing needs, manage length of stay, promote efficient utilization of resources and ensure that care meets evidence-based practice standards and regulatory/payor requirements.
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Requires a demonstrated progressive understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, product pricing, network and provider contracting, and utilization management.
$129,570 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Case Management Care Coordinator, Utilization Management is a member of the healthcare team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment.
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Delegates and supervises the utilization of Physical Therapy Assistant and supportive personnel to maximize patient outcomes and insure effective utilization of services. Possesses the skills and knowledge to communicate, perform treatments, assess and interpret age specific data and issues of pediatric, adolescent, adult and geriatric patients in their plan of care.
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Role Description This is a full-time on-site role for a RN Hospice Case Manager in Edgewater, NJ. The RN Hospice Case Manager will be responsible for discharge planning, utilization management, nursing, medicine, and case management.
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Assists management in developing cost accounting methodology and model to enable NBMC to determine costs of nursing care and other direct costs and to provide information for NBMC planning and decisions (e.g., pertinent elements of patient care, labor, non-labor, and indirect allocation.
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Collaborates and educates the medical staff on appropriate utilization review guidelines and documentation in accordance with CMS regulations and Commercial payors guidelines. POSITION SUMMARY:Performs concurrent utilization review activities on all patients within the assigned caseload.
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Five (5) years of experience in an acute care setting, which must include at least two (2) years of experience in utilization review/case management/quality improvement leadership position required.
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Oversee population health management initiatives, including risk stratification, care coordination, and patient engagement strategies to improve health outcomes and reduce healthcare disparities.
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care utilization jobs in Passaic, NJ
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