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Responsible for oversight of defined Health Services programs, services, and functions which may include, but not be limited to, health management, behavioral health services, care management, utilization management, grievance and appeals, claim review, and policy/procedure development.
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Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. 2+ years of healthcare/managed care experience, preferably in the following related areas of responsibility: Utilization Management and/or Quality Management.
$24 - $35 an hourFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Currently recruiting a Registered Nurse (RN) Case Manager near Palm Springs, California , to provide care to family members of Active Duty heroes in the Wounded, Ill, and Injured Warriors (WII) under the Psychological Health Transition to Care Initiative in the Case Management/Utilization Management Division at Naval Hospital 29 Palms.
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Job Description & Requirements Specialty: Case Management Discipline: RN Duration: Ongoing 36 hours per week Shift: 12 hours Employment Type: Staff Job Summary: Provide integrated and coordinated case management services for the high risk and high utilizer populations in both inpatient and outpatient psychiatry and addiction medicine settings.
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The Utilization Management Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS. The Utilization Management Nurse III is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services.
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You will oversee utilization management process including verification of insurance coverage, pre-authorization, resource management and overall management of patients within the continued stay criteria.
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The Case Manager (CM) / Utilization Review (UR) nurse staff augmentation full time role will temporarily fill in for Optum care management teams for short term staffing as well as provide consultative support to the front-line care management team, as appropriate.
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Under the direction of the Director, Care Coordination, the Utilization Review RN performs activities which support the Utilization Management functions. The Utilization Review RN is responsible for the delivery of the Utilization Management process not limited to and including: making clinical recommendations regarding medical necessity for admission and continues stay, screens patients for client specific guidelines regarding insurance, Medicare and/or Medicaid guidelines, send payor specific Notice of Admission and continued stay reviews.
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Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator.
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As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team. Utilization review, prior authorization, Care management, Case management, interqual, ncqa, ncqa standards.
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Huntsville Hospital Urgent Care, with nine locations in Alabama, is an affiliate of Urgent Team, one of the largest independent operators of urgent and family care centers in the Southeast.
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As a member of the Care Management team, our Care Management Nurses and Clinicians provide clinical care management to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes – all in service of making our members’ health journeys easier.
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Experience in quality, care coordination, utilization management in an inpatient, ACO or FQHC environment. Administrative practices and procedures including but not limited to quality assessment and improvement, care coordination, utilization review, peer review, credentialing and risk management.
$118.44 - $165.82 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Current working knowledge of discharge planning, utilization management, case management, performance improvement, disease or population management and managed care reimbursement.
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Participates in other high risk multidisciplinary complex case staffing as needed to include Vaya CMO/ Deputy CMO, Utilization Management, Provider Network, and Care Management leadership to address barriers, identify need for specialized services to meet client needs within or outside the current behavioral health system.
$64,793.66 - $93,950.81 a yearFull-timeExpandApply NowActive JobUpdated Today
family care team utilization management jobs Title: rn case manager Company: Spartanburg Regional Healthcare System in Raleigh, West Virginia
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