- Presbyterian Homes and Services (Roseville, MN)
- …of denials/ communicate at IDT + Site specific education + Key measure management Qualifications + Registered nurse with current licensure from the State ... Auditing RUG grouper/MDS end splits + Reviewing all expedited appeals and ALJ level appeals + Monthly...process. + Experience with MDS completion, reimbursement, clinical resource utilization and/or case management . + Ability to… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …bilingual Spanish speaker * 1+ years of managed care experience; eg case management /health coach, utilization management and/or auditing experience. * ... across the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and… more
- NHS Management, LLC (Tuscaloosa, AL)
- …services at the highest practicable level for each resident. Provides case management services for certain high-risk Medicare Part A residents to ensure services ... with the assessment and the plan of care. QUALIFICATIONS + Must be a Registered Nurse in good standing in the state(s) in which assigned + Must be knowledgeable in… more
- Calvary Hospital (Bronx, NY)
- …pertinent data. 8. Knowledge of and experience in Quality Assessment and Improvement, Utilization Review. 9. Ability to develop management systems to track data ... to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts… more
- System One (Las Vegas, NV)
- …enterprises across the United States, specializing in Program & Project Management , Application Development, Cybersecurity, Data & Advanced Analytics, and Agile ... Services. The LTSS Coordinator - Nevada monitors and promotes effective utilization of long-term services and supports through clinical review and benefits… more
- Molina Healthcare (Tacoma, WA)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …within the KidsPeace medical community when necessary. + Medication Management - Prescribe and monitor medications within established pediatric standards. ... & Supervision - Assume a leadership role regarding the clinical management of patients/clients in programs assigned. Establish as necessary collaboration/supervision… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …limit the use of restraints or other safety measures. Medication Management - Prescribe medications within established psychiatric practice standards, monitor ... & Supervision - Assume a leadership role regarding the clinical management of patients/clients in programs assigned. Establish as necessary collaboration/supervision… more