- Houston Methodist (Houston, TX)
- …oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for the ... and advancement of a unified case management model grounded in clinical excellence, throughput efficiency, care transitions, and denials prevention. A champion… more
- Saint Francis Health System (Tulsa, OK)
- …Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), or Professional ... concise summaries. Essential Functions and Responsibilities: Meets time requirements for review intervals, supplying the required clinical information to obtain… more
- System One (Las Vegas, NV)
- …monitors and promotes effective utilization of long-term services and supports through clinical review and benefits management. Essential Functions: + Serve as ... homes. + Coordinate, oversee, and provide insights into the clinical documentation system for processing approvals and denials, notify...team of LTSS approvals and denials, and support the appeals process as needed + Collaborate with Care Managers… more
- Corewell Health (Royal Oak, MI)
- …criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization ... adult and Level II pediatric trauma designations. The advanced capabilities and clinical expertise within this center have earned it Magnet designation four… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …and Statistical Manual of Mental Disorders, written treatment orders, admissions on-call review for all legal commitment status documents and review and ... Leadership & Supervision - Assume a leadership role regarding the clinical management of patients/clients in programs assigned. Establish as necessary… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …history and physical examination, either written or dictated. This includes a review of the immunization status, allergies, past history, family history and ... Leadership & Supervision - Assume a leadership role regarding the clinical management of patients/clients in programs assigned. Establish as necessary… more
- BAYADA Home Health Care (Pennsauken, NJ)
- …risk advisement to leadership, policy revision, additional monitoring as needed. + Review clinical documentation to assure records meet all regulatory and ... (4) year college degree and must be a Registered Nurse . + Three (3) or more years of hospice...or more years experience managing external audits and writing appeals . + Possess a strong understanding of the current… more
- Corewell Health (Dearborn, MI)
- …criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization ... + Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). + Responsible for managing… more
- Calvary Hospital (Bronx, NY)
- …to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts ... interdepartmental meetings related to the quality and utilization of clinical services. Serves on various Hospital committees as assigned. Attends meetings and… more