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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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TAUC is a member of the Urgent Care Group Network which includes more than 57 centers operating as six brands: Covenant Health Urgent Care in partnership with Covenant Health in Tennessee, Health Choice Urgent Care in partnership with Northside Hospital in Georgia, Medac Urgent Care in North Carolina, MEDcare Urgent Care in South Carolina, ParkMed Urgent Care in Tennessee, and Total Access Urgent Care in Missouri.
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A healthcare organization in New York City is currently seeking a Cantonese, Mandarin, and/or Spanish-speaking Licensed Clinical Social Worker (LCSW) and/or Licensed Master Social Worker (LMSW) to join their team in the Bronx as a Social Work Care Manager.
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Manages a patient session schedule allowing for both scheduled and non-emergent unscheduled visits; maintains a work schedule that ensures availability and continuity of care; ensures optimal availability and utilization of appropriate resources.
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Monitoring of network uptime, availability, bandwidth utilization, configuration change monitoring and backups. Industry certifications : Checkpoint, Cisco, Fortinet, CISSP, GIAC, CISA, SANS GCFA, GCED, GMON.
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Here at Optum , part of the largest network of medical groups in the nation, we are seeking a dedicated and patient-centric Nurse Practitioner or Physician Assistant to join our growing Adult Primary Care team in the Northern New Jersey market with Optum Tri-State ( i.e., previously a Riverside Medical Group practice.
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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. VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position.
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About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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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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Conduct capacity planning and resource utilization analysis to support scalability and growth of Oracle/Exadata environments. We are seeking a skilled Oracle Database Administrator (DBA) with extensive experience in managing Exadata environments to join our team.
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At NewYork-Presbyterian Hospital, Certified Registered Nurse Anesthetists (CRNAs) deliver incredible care that is unseen anywhere else in the world. In addition to providing excellent care, our CRNA’s also provide one-on-one anesthesia instruction for Columbia University’s Nurse Anesthesia Program.
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St. Francis Hospital is dedicated to providing a supportive environment, committed to the highest standards of patient care, where health care professionals can develop their expertise and strengthen their credentials.
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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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Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care. One or more of the following licensure is required for this role with necessary degrees: CEAP, LMSW, LCSW, LPC, RN or LPN. Minimum 2 years experience post degree in healthcare, behavioral health, psychiatric and/or substance abuse health care setting.
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Externally, the UM Coordinator will interface with licensing and accrediting agencies, managed care companies, family members, and healthcare treatment agencies. 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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utilization care jobs Company: Metroplus Health Plan in Brooklyn, NY
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