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Director Care Coordination- Major Responsibilities Criteria A: Establishes and coordinates communication with all Utilization Regulatory Agencies i.e. Qualidigm, NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials.
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Qualified candidates will have prior LTSS or Medicare Inpatient Utilization Management experience within a Managed Care setting, LTSS, MLTC MAP, will have a NYS Registered Nurse License , familiar with MCG/Milliman/Interqual Guidlines and a desire to join a great team.
$102,000 - $107,000 a yearFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Knowledge of utilization management procedures, mental health and substance abuse community resources and providers. Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.
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The Utilization Management Coordinator is responsible for all utilization management activities for assigned cases from admission through discharge, including peer reviews and appeals, in accordance with the Utilization Review Plan, for patient population ages 5 years through 21 years, with significant behavioral health needs and Autism Spectrum Disorders or other developmental disorders.
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Qualifications: High School Diploma or equivalent; college degree preferred One year prior managed care experience required Prior experience in a health care setting preferred Familiarity with utilization management/case management.
$42,401 - $53,001 a yearPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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You have a broad knowledge of health care delivery/managed care regulations, contract terms/stipulations, prior utilization management/case management experience, and governmental home health agency regulations.
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By leading market level projects and strategies for provider engagement, this position will drive optimal performance on quality, risk adjustment, utilization management, financial performance, and membership growth.
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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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Participate in job-related committees, such as Substance Abuse, Utilization Management, Safety, and Risk Management. Engage in clinical collaboration in the coordination of services with other third-party agencies, such as Child Protective Services (CPS), Probation/Parole Department, Division of Developmental Disabilities, Arizona Long Term Care, schools, and other providers.
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Monitors patient’s hospital length of stay and collaborates with MSO Utilization Management (UM) team and PCPs to ensure resource utilization are appropriate in relationship to the patient’s clinical and psychosocial needs.
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The Department of Risk Management at SUNY Downstate Health Sciences University is seeking a full-time Risk Management Coordinator / TH Utilization Review and Quality Assurance Senior Coordinator.
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Possessing working experience in Payer or Provider operations (domain areas such as Medical Management, Population Health Management, Utilization Management, Provider Network Management, Value-Based Contracting, Provider Relations, Quality Improvement, Informatics, ACO operations, etc.
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Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e. Enrollment and Membership Services, DST BPO and Utilization Management) As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics.
Full-timeExpandApply NowActive JobUpdated 23 days ago - UpvoteDownvoteShare Job
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Providing oversight, direction and leadership of Care Coordination functions including utilization management, discharge planning, case management, length of stay management, and the appeals/denials process.
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Summary: Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing.
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utilization management care jobs in Brooklyn, NY
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