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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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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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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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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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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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Care New England Health System (CNE) and its member institutions; Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.
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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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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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Monitoring of network uptime, availability, bandwidth utilization, configuration change monitoring and backups. Manage and control vulnerability management and security incidents of the Americas Region in collaboration with the HO.
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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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Experience in at least 3 ServiceNow Applications such as IT Service Management(ITSM), Customer Service Management (CSM), Strategic Portfolio Management (SPM), IT Asset Management(ITAM), Governance Risk Compliance (GRC), IT Operations Management (ITOM) etc.
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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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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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They also engage in population health management in a sophisticated, outcomes-driven manner that promotes palliative care where clinically appropriate and focuses on patient education, autonomy, and quality of life.
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Conduct capacity planning and resource utilization analysis to support scalability and growth of Oracle/Exadata environments. Utilize Oracle Enterprise Manager (OEM) for deployment, monitoring, and management of Exadata environments.
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utilization management care jobs Company: Metroplus Health Plan in New York, NY
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