- Arnot Health (Elmira, NY)
- …related to the management of patient care . The Case Manager will review all patients for utilization management and appropriate discharge planning. The ... the guidelines. . Identifies the appropriate patients for Case Management services. . Maintains a working knowledge of the...The Case Manager tracks and trends LOS , resource utilization , outliers, readmissions , denials , delay days… more
- ChenMed (Chicago, IL)
- …explain primary care provider role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... re: goals of care, palliative care and hospice. + Utilization /Financial Management -managing resource utilization and...quality of health care. + Applies skills in peer review to promote a culture of excellence. + Anticipates… more
- Centene Corporation (Bedford, NH)
- …abuse across the continuum of care required + Experience with managed care, case management , utilization management , or quality improvement required + For ... groups and providers regarding clinical information from the Operations and Medical Management teams. Assesses and performs review of member clinical records… more
- Humana (Lincoln, NE)
- …management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
- Truman Medical Centers (Kansas City, MO)
- …in English, both spoken and written **Preferred Qualifications:** + RN experience in hospital utilization review , utilization management , or case ... you will identify patients who would benefit from case management services and coordinate care across the continuum by...+ Assess patient needs and determine eligibility for case management services + Collaborate with patients, families, and the… more
- Calvary Hospital (Bronx, NY)
- …and identify the expected length of stay (ELOS). The RNCM participates in the Utilization Review , Discharge Planning, Risk Management , and Quality Assessment ... Qualifications: + Five (5) or more years experience in either Utilization Management , Quality Assessment and Improvement, Risk Management , and/or Discharge… more
- St. Luke's University Health Network (Allentown, PA)
- …in order to facilitate a positive outcome for patients. + Assists in the utilization management of psychiatric patients. + Maintains clinical records of all ... + Provides case management duties as assigned by Supervisor. Case Management duties include individual assessments, utilization reviews, family or support… more
- Stony Brook University (Stony Brook, NY)
- …telephonically post-discharge and assist with barriers to care * Prior experience with Care Management or Utilization Management * Understand levels of care ... is provided to the patients. * Documents the case management plans such as clinical needs, barriers, utilization...or for a maximum of 90 days. An initial review of all applicants will occur two weeks from… more
- East Boston Neighborhood Health Center (Revere, MA)
- …as it relates to timely and accurate claims payment and improvements to utilization management . + Responsible for maintaining up-to-date knowledge of fee ... . Time Type: Full time Department: PACE Health Plan Management All Locations: 300 Ocean Avenue - Revere Position...Coordinating with the Manager of PACE Claims to proactively review referrals and claims-related data in an effort to… more
- Penn Medicine (Plainsboro, NJ)
- …timely and accurate information to payors. The role integrates and coordinates utilization management , care facilitation and discharge planning functions. In ... the multi-disciplinary care team to effect timely, appropriate patient management .Addresses/resolves system problems impeding diagnostic or treatment progress. Proactively… more
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