- LA Care Health Plan (Los Angeles, CA)
- …the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires extended review. ... based on clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more
- Corewell Health (Grand Rapids, MI)
- …+ Support the lead for expedited requests, gathering relevant information, working with Medical Director to determine if criteria is met. If expedited criteria ... payment, care management, authorizations, customer service interactions, pharmacy Rx profiles, medical policies and plan documents for Medicare product lines… more
- AdventHealth (Shawnee, KS)
- …**All the benefits and perks you need for you and your family:** + Vision, Medical & Dental Benefits from Day One + Student Loan Repayment Program + Received Magnet ... **The community you'll be caring for:** At AdventHealth Shawnee Mission, formerly Shawnee Mission Medical Center, you're more than just a number on a chart. You're a… more
- Mount Sinai Health System (Brooklyn, NY)
- …+ High school diploma/GED required; college degree preferred + Knowledge of medical terminology + Excellent customer relations and interviewing skills, ability to ... receipts to Accounts Payable 8. Process parking, food services, radiology, medical records requests, subpoenas, private room transactions and create cloud e-receipts… more
- County of Northampton (Nazareth, PA)
- …employment opportunities (EEO) to all persons regardless of race, color, national origin, religion, sexual orientation, marital status, sex, gender identity, gender ... and provides clinic nursing care, and assists with providing nursing and medical support services to residents and employees at Gracedale Nursing Home. The… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques with members and… more
- Mount Sinai Health System (New York, NY)
- …workflows and quality reporting measures. This position will report to the Director of the Enterprise CDM. **Qualifications** + Bachelor's degree in public ... working with the Professional Charge Description Master, preferably in an academic medical center. + 5 plus years with Epic Experience, Epic certification desirable.… more
- University of Colorado (Aurora, CO)
- **Peer Recovery Specialist Patient Services** **Description** **University of Colorado Anschutz Medical Campus** **School of Medicine | Department of Psychiatry | ... of health such as issues of housing, transportation, Medicaid and/or Medicare enrollment, food/nutrition, access to health care, provide referrals to necessary,… more
- CenterWell (Anderson, SC)
- …active participant and leads the care team through daily huddles. + Helps Associate Medical Director (AMD), Physician and Center Administrator in setting a tone ... accordance with standards of care. + Follows level of medical care and quality for patients and monitors care...be screened for TB. **Preferred Qualifications** + Experience managing Medicare Advantage panels of patients with understanding of best… more
- AdventHealth (Orlando, FL)
- …under the general supervision of the Care Managment Supervisor or Manager or Director of Nursing and is responsible for patient evaluations of post-hospital needs; ... Care coordination, discharge planning, transitions of care planning and understanding of medical necessity are core competencies of this role. The RN Care Manager… more