- AdventHealth (Shawnee, KS)
- …for individuals from at-risk populations from interdisciplinary team members (including physicians, RN Care Managers, staff nurses, and other members of the care ... The Social Worker is under the general supervision of the Care Management Supervisor or Manager and is responsible for patient evaluations of post-hospital… more
- Catholic Health Services (Roslyn, NY)
- Overview Director-Care Management Are you exceedingly driven, dedicated, and passionate about caring for your patients? Do you consistently create and nurture ... to be a St. Francis Hospital & Heart Center(R) RN . You are at the heart of health. St....and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, resource utilization… more
- Covenant Health Inc. (Knoxville, TN)
- …or staff education. Also provides consulting services to the organization's management and staff and may participate in requested investigations. Maintains all ... of audit and consulting projects via written reports and oral presentations to management and audit committee. + Documents all audit activities in a designated… more
- Eastern Connecticut Health Network (Manchester, CT)
- …accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing unnecessary ... concurrent, and retrospective reviews in accordance with the utilization management plan. The UM CM ensures the appropriate status...or a related field. + Current licensure as an RN . EXPERIENCE: + 2 - 3 years' experience in… more
- CaroMont Health (Gastonia, NC)
- …via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments, Care ... Management and Senior management as necessary. Retrospectively... as necessary. Retrospectively reviews medical record for clinical denials . Composes a detailed summary of care and sends… more
- UnityPoint Health (Des Moines, IA)
- …of patient-focused care for prioritized patients . + Documents the case management plan to include: clinical needs, barriers to quality care, effective utilization ... of resources and pursues denials of payment and referrals in a timely, legible...timely, legible manner. + Tighter integration with ambulatory care management team, especially with high risk, chronically ill patients.… more
- Trinity Health (Nampa, ID)
- …requested by third party payers and Medicaid. + Responsible for appeals, denials , as appropriate. Utilizes physician advisor referral as appropriate. + Will adhere ... coordination activities for those patients identified as requiring case management interventions to decrease fragmentation, increase communication and ensure… more
- Henry Ford Health System (Troy, MI)
- …workflows. Primary areas of focus include revenue capture accuracy, decreased denials utilizing standard optimized workflow, and reducing organization risk by ... and tracks utilization. Due to its service focus and project management emphasis, this position requires strong interpersonal and communication skills,… more
- Mount Sinai Health System (New York, NY)
- …highly desirable. + Excellent interpersonal skills and experience working with senior management and other leaders, along with the ability to communicate concepts to ... communication and organizational abilities. Accuracy, attentiveness to detail and time management skills are required. + Ability to interact effectively with… more
- St. John's Embrace Living (Rochester, NY)
- …Degree in Social Work or Human Services OR Bachelor's Degree in Nursing or NYS RN Licensure OR Licensed Practical Nurse (LPN), with a minimum of three years' ... continuous communication with families & various community care partners, bed management , and oversight of the admission paperwork. Works in collaboration with… more