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They monitor the case-mix index for services and hospital entities, Vizient and hospital-related quality initiatives (e.g., patient safety indicators, pressure ulcer monitoring, mortality reviews, etc.
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Maintains knowledge of current concepts, research needs and research strategies related to case management, utilization review and discharge planning. Collaborates with the Utilization Review Specialist RN regarding medical necessity of inpatient admission, appropriate patient class and duration of hospitalization.
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As the Director of Case Management , you will use your clinical knowledge and contribute to the overall functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management, discharge planning, treatment plan management and financial management effectiveness.
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Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
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Customer service principles; Criminal Justice system, laws, legal codes, and court procedures; Interview and Assessment procedures and practices; Intervention policies and procedures; Cognitive skill building, motivational learning; Social learning theory; Crisis intervention techniques; Modern office procedures and equipment; Recordkeeping principles; Document review techniques; Computers and related software applications.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Nursing experience may include inpatient nursing, case management, utilization review, discharge planning, community health nursing. Family Experience: Visit our website: The Care Coordination Nurse is responsible for ensuring the provision of quality patient care in the appropriate setting through care coordination, case management, utilization management of inpatient admissions, and transitions of care to different levels of care.
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As a Surveillance Investigator at Ethos Risk Services, you will conduct covert surveillance, review files, and draft detailed case reports. As a Surveillance Investigator at Ethos Risk Services, you will conduct covert surveillance, review files, and draft detailed case reports.
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Under the direction of the Director of Inpatient Coding and Compliance, the Senior Coding Education and Data Consultant assists in determining controls and monitors risk areas or changes to review risk management and ensure compliance with documentation and coding regulations.
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Performs clinical services in the field, including but not limited to wound care dressing changes, phlebotomy, medication review, and patient status checks. Provides clinical services and clinical coordination services as directed by a patients clinical risk assessment and clinical care plan and under the clinical supervision of providers, Practice Manager, and RN Case Managers.
$28 - $30 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Schedule a Case Conference/IDG with assigned RN to review patient's needs, problems, level of care and any changes in plan of care, including hospice admission with patient consent. HarmonyCares is a family of companies all dedicated to providing high-quality, coordinated health care in the home.
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Prior to submitting your application, please review and update (if necessary) the information in your candidate profile as it will transfer to your application. For answers to additional questions please review the frequently asked questions.
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As the domain expert for cybersecurity, you will provide leadership oversight and guide the team throughout new product's development phases, review of product security requirements and recommendations of security design solutions, complete quality documentation, threat modelling, penetration testing, software architecture review and design recommendations, code analysis and other security testing work as needed.
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Responsibilities include medical review, which involves in-house review of Case Report Forms (CRFs) including query resolution and addenda writing, QA of data listings. In depth investigation of medical adverse events and works with Medical Affairs, Clinical, and Regulatory Affairs in the preparation of documentation on adverse events for the FDA; or Medical Communication which includes writing standard and custom responses to communication requests.
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Preparing the draft of protest and termination case documents for review and approval by the Contracting Officer. Fully remote position - 100% telework in the U.S. Medical, Tri-Care Supplement, dental, vision, HSA, FSA, insurance (STD, LTD, life, AD&D, voluntary life, accident, hospitalization, critical illness), EAP, and additional discounts.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Case management, Nurse. Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to programs and plans.
$44 - $45 an hourExpandApply NowActive JobUpdated 4 days ago
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