- HCA Healthcare (Derry, NH)
- …state Registered Nurse license + Two or more years of clinical experience. + Case Management , Utilization & Managed Care experience and 1 or more years of ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services...medical necessity, admission status, level of care, and resource management . + The RN Case Manager Team Lead will… more
- University of Pennsylvania (Philadelphia, PA)
- …academic programs outside of Penn and/or other academic project management responsibilities. Job Description Job Responsibilities 1. Provide executive-level ... all correspondence, written materials, documents are prepared in timely manner for review and distribution to meet all deadlines. Also ensures that all documents… more
- Northern Light Health (Unity, ME)
- …Quality Assurance, AOA and other governmental agencies. + Performs periodic review of established processes to assure staff understanding to identify opportunities ... Provider chart note completions + Assists with fiscal analysis and resource utilization for program development initiatives. + Ensures the approval process for… more
- State of Colorado (Pueblo, CO)
- …also provides support to the Pack CARES team by participating in case review , documentation, and coordinated care efforts. This is a .83 FTE position intended ... needs from August through May. Primary Duties Non-Clinical Case Management + Provide case management services for...meetings and report progress related to student goals and utilization of resources. + Maintain repository of university and… more
- UnityPoint Health (Iowa City, IA)
- …services. * Is knowledgeable regarding managed care implications - precertification and utilization review procedures. * Assists with crisis services placement, ... patient staffing's and special care conferences. Assist with designated management duties in a leadership role. The patients served...where applicable. * Provides consultation regarding behavioral health issues as needed to other departments. *… more
- US Tech Solutions (Columbia, SC)
- …quality, cost effective outcomes. **Responsibilities:** + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services ... 1-2 weeks then remote training. + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise,… more
- State of Connecticut, Department of Administrative Services (Bridgeport, CT)
- …initiatives; + Prepares and/or reviews reports, medical records and correspondence; + Performs utilization review and management functions; + Attends court ... mission is to promote the overall health and wellness of persons with behavioral health needs through an integrated network of holistic, comprehensive, effective and… more
- Community Hospital Corporation (Greenville, TX)
- …capital and equipment acquisitions. + Direct the development, implementation, and utilization of an appropriate productivity management system. + Responsible ... of the annual cost reports. + Responsible for the review of management and service contracts in...Cancer Center, advanced digital imaging (CT, MRI, 3D mammography), behavioral health services, and robotic surgery. For more information,… more
- Highmark Health (Columbus, OH)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... both internally developed and vendor-sourced criteria. This includes proactive monitoring, review , and timely updates in response to new evidence, regulatory… more
- Atlantic Health System (Summit, NJ)
- …assessment, including SDOH and multidisciplinary collaboration. 2. Ensures daily chart review , utilization reviews, coordination of discharge planning activities ... selected member populations across the continuum of illness. Ensures effective utilization and monitors health care resources. Manages the interdisciplinary team to… more