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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 2 days ago - UpvoteDownvoteShare Job
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Provide utilization management services to patients of Coordinated Health Care employer groups with catastrophic illnesses and/or injuries. 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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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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Duties include but may not be limited to wound care, including NPWT/VAC, Peg/Trach Care Management, Foley insertion and catheter care management, JP/PleuRx Drain care, administering injections.
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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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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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Information Security Processes: Identity and access management, privileged access management, generic ID management, threat intelligence, vulnerability management, secure coding practices, data security and encryption, phishing, forensics, mobile security, third-party, etc.
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Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management.
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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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Primary duties of the Trash Collector include: - Operating garbage trucks - Collecting and dumping trash receptacles - Following route assignments as directed Waste Management offers an excellent benefits package that includes medical, dental, vision, life, 401(k) savings and more.
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Submit your application now to become a Trash Collector with Waste Management! Waste Management is currently accepting applications for a Trash Collector! Submit your application now to become a Trash Collector with Waste Management.
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Ares offers a number of additional benefits including access to a world-class medical advisory team, a mental health app that includes coaching, therapy and psychiatry, a mindfulness and wellbeing app, financial wellness benefit that includes access to a financial advisor, new parent leave, reproductive and adoption assistance, emergency backup care, matching gift program, education sponsorship program, and much more.
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utilization management care jobs Company: Metroplus Health Plan in Brooklyn, NY
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