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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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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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VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. RN- Utilization Review Nurse. Seeking those who bring a BSN (advanced degree preferred), along with 2+ years of utilization review experience at a Managed Care Organization or Health Plan required.
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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 2 days ago - UpvoteDownvoteShare Job
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Professional Fee Specific: Responsible for coding Surgical Records, Evaluation & Management Encounters, ED (with E&M) and as needed Diagnostic, HCC, Retrospective Coding, Documentation Quality Assurance, and Ancillary records.
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We are seeking a Utilization Review Nurse (LVN/RN) with strong clinical judgment to join our team at a Managed Care Organization in New York. In this role, you will play a pivotal role in ensuring high-quality, cost-effective care for patients, facilitating their journey towards maximum medical improvement while receiving medically necessary treatment.
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This experience typically includes: monitoring occupant space utilization, energy and water conservation, sustainability and environmental hazards programs; coordinating alteration and renovation projects; gathering information to assess the level of customer satisfaction, i.e., surveys, interviews with tenant contacts, focus groups; monitoring real property budgetary and financial data; and, administration of repair and/or operation and maintenance contracts.
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Design of electrical power generation, distribution and utilization systems including high-voltage main and secondary substations, power distribution equipment, protective relaying and metering, electrical power generating equipment and systems, UPS and power conditioning systems, lightning and surge protection systems, motors and motor controls, indoor/outdoor lighting systems, electrical heat tracing, wiring methods and/or grounding systems.
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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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For activities of professional and non-professional staff in delivering a health therapy program and support services including physical, occupational, inhalation specialties, radiological, laboratory, emergency, ambulatory care services, medical utilization review and quality assurance.
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O Be supported by excellent ancillary services, including perinatal education, behavioral health, lactation services, dietitian, dental, and case management. o Provide family-centered and reproductive-justice-oriented care in a trauma-informed environment.
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Lead the strategic implementation and optimization of all marketing systems and platforms with a focus on digital asset management (DAM) systems, ensuring the efficient organization, retrieval, and utilization of the company's vast library of visual assets.
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This position is responsible for the planning, scheduling, budgeting, utilization and reliability of a marine construction equipment fleet. The position will de Equipment Engineer, Construction, Engineer, Equipment Manager, Equipment Repair, Mechanical, Manufacturing.
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This will also include a basic understanding of boiler operating principals and ancillary system functions. Minimum of three (3) years of experience in one or more of the following areas is required: combined cycle plant, boiler operator, electrical/mechanical technician, mechanic,pipe fitter, welder, plumbing, electrical, welding similar military experience.
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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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utilization ancillary jobs Company: Metroplus Health Plan in Brooklyn, NY
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