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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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Piper Companies is currently seeking a Remote Utilization Management Nurse for a remote opportunity within a health insurance organization. The Remote Utilization Management Nursewill be serving as an essential bridge between health care and medical coverage.
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This role focuses on improving the health status and connection to resources, preventive care, hospital follow-up, and ongoing healthcare for individuals with chronic health conditions as well as addressing frequent hospital and emergency department utilization, and medical, behavioral health, and psychosocial needs by performing care management and care coordination functions in a variety of settings that include a patient’s home, community, and clinic.
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UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends. Please note: As a condition of employment, if not already completed, all new hires are required to receive the first dose of the COVID-19 Vaccination Series prior to their Occupational Health pre-employment assessment, and scheduled to complete the Vaccine Series within the first thirty (30) days of employment.
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The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women's health, urgent care and emergency services.
$40.28 - $66.78 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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JOB OVERVIEW:The Family Resource Coordinator works in collaboration with their teammate, the Child First Clinician, to coordinate/provide community-based case management and mental health support services to the families on their caseload.
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Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required.
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VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in North Bergen, New Jersey. Collaborates with professionals, health plan departments such as Claims and Medical Management, and the third party administrator staff and legal, as necessary, to investigate and facilitate resolution of individual grievances and appeals.
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Implement a plan of care and monitor patient's response: Provide individual/family counseling, and social work intervention, as it relates to complex crisis management, mental illness, adjustment to illness, material assistance, healthcare decision-making, sexual assault, domestic violence, partner violence, elder abuse, competency, and any other psychosocial barriers in order to maximize the health status of patients.
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By using Interqual criteria, policies, regulatory guidelines and other standards of care, the Coordinator for Utilization Management (UM) will collaborate with other health care providers to evaluate the appropriateness of utilization and the medical necessity of care, for elective and emergency admissions, surgeries, diagnostic procedures and treatments.
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Child First has been recognized as an evidence-based home visiting model by the U.S. Department of Health and Human Services (HHS) under the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program and rated “Effective” by the National Registry for Effective Programs and Practice (NREPP) of the Substance Abuse and Mental Health Service Administration (SAMHSA.
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Overseeing the post-acute care arrangements for patients on ECMO or home ventilators. From admission to post-discharge, our Care Management team is there to assure care is appropriate, timely, cost-effective, and of high quality.
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The Mental Health Counselor / Therapist of Family First Preservation & Reunification Services (FFPRS) will provide comprehensive bio-psychosocial assessment, treatment planning, and clinical services in accordance with FFPRS programming, agency standards and Family First approved evidence-based practices.
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Intraoperatively performs surgical first assistant techniques: uses instruments and medical devices; provides surgical site exposure, handling and cutting tissue, providing hemostasis suturing wound management as appropriate; may participate in post op rounds and assist with discharge planning and identification of appropriate community needs.
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The goals of Case Management include the achievement of optimal health, access to services, advocacy, appropriate utilization of resources, collaboration with post-acute care providers to ensure patient's needs are met in the community, and to provide timely clinical reviews to payers.
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home health first utilization management jobs Title: coaching Company: Humana in Yellowstone-national-park, Wyoming
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