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Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation.
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Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type.
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Works with Utilization Review staff relative to data tracking for performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process.
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Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
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Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum of care. Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company.
$69,800 - $96,200 a yearFull-timeExpandApply NowActive JobUpdated 2 months ago - UpvoteDownvoteShare Job
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Become a part of our caring community and help us put health first. Competently performs patient care assignments and staff management activities. Reviews available patient information related to the case, including disciplines required, to determine home health or hospice needs.
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As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients.
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Two years as a Registered Nurse with at least one-year of management experience in a home care, hospice or equivalent environment. About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization.
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Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it.
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We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. Conducts/delegates the assessment and reassessment of patients, including updating of care plans and interpreting patient needs, while adhering to Company, physician, and/or health facility procedures/policies.
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Instructs and guides clinicians to promote more effective performance and delivery of quality home care services, and is available at all times during operating hours to assist clinicians as appropriate.
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The Clinical Manager coordinates and oversees all direct care patient services provided by clinical personnel. Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by Utilization Review staff.
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