- BAYADA Home Health Care (Pennsauken, NJ)
- …track KPI, such as incident resolution, audit readiness, training completion, and policy utilization . + Serve as project manager for key compliance program ... health or healthcare organization. + Executive presence to represent BAYADA Home Health Care internally and externally. + A working understanding of the home health… more
- Hartford HealthCare (Mansfield Center, CT)
- …patient care decisions to support optimal clinical and operational outcomes. They review visit utilization for care appropriateness and collaborate with ... to ensure quality and reliability. Guides staff on clinical, documentation, and utilization decisions to improve OASIS accuracy and care quality, recommending… more
- Ventura County (Ventura, CA)
- …The ideal candidate is an experienced Mental Health Nurse with a background in utilization review and discharge planning. They also have extensive years of ... and review ; + Performs daily clinical reviews to support utilization and quality management, ensuring compliance with guidelines and standards for patients… more
- The County of Los Angeles (Los Angeles, CA)
- …techniques and methodologies to analyze large-scale service utilization data (eg, service utilization by CPT codes, level of care , and provider type, and ... to make better financial, business, policy and operational decisions in managing costs, utilization , and quality of care as well as financial risk management.… more
- Battelle Memorial Institute (Cannon AFB, NM)
- …tasks assigned by the HP program Manager and/or Coordinator + Document care provided, work performed, utilization , referrals, and all other information in ... and administrative duties as assigned by the HP program Manager or Coordinator. **Responsibilities** + Function across the spectrum...scope of practice + Participate in periodic meetings to review the care provided to patients to… more
- Hartford HealthCare (Southington, CT)
- …patient care decisions to support optimal clinical and operational outcomes. They review visit utilization for care appropriateness and collaborate with ... to ensure quality and reliability. * Guides staff on clinical, documentation, and utilization decisions to improve OASIS accuracy and care quality, recommending… more
- Fallon Health (Worcester, MA)
- …according to department protocol * Collaborates with attending physicians and health care professionals regarding appropriate utilization of medical services * ... * Requests and obtains relevant clinical information from medical care providers as needed for the clinical review...clinical setting required. * 2 years' experience as a Utilization Management/Prior Authorization nurse in a managed care… more
- Battelle Memorial Institute (Columbus, OH)
- …the effects of physical training protocols under the supervision of the HP program Manager and/or Coordinator + Use statistics and analytics to track and report on ... portion of the HP program to the HP program Manager and/or Coordinator and HP staff + Conduct and...and conditioning equipment + Participate in periodic meetings to review and evaluate physical training programs and identify opportunities… more
- Molina Healthcare (Sterling Heights, MI)
- …Qualifications * Experience with utilization /quality program management. * Managed care experience. * Peer review experience. * Certified Professional in ... and clinical leadership for health plan and/or market specific utilization management and care management behavioral health...Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager … more
- KBR (Houston, TX)
- …current with the provision of care . + Provide input for the development and utilization of required databases. + Conduct peer (record) review s for the HP ... . We maintain a highly qualified workforce to help care for service people and astronauts across the world...POTFF Staff, and as directed by local HP program manager and/or coordinator. + Document work performed, utilization… more