Case Management and Utilization Review

Selected news for the healthcare topic - Case Management, and the healthcare topic - Utilization Review. We have 135 shared news items for this connection to-date.

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Date Headline (link) Source Relevant Snippet
4/22/2022 QUALITY IMPROVEMENT ORGANIZATION PROGRAM & OVERSIGHT MANAGER (PROGRAM MANAGER II - FULL TIME CONTRACTUAL) - #22-005477-0019 ... the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. The QIO provides oversight of the DDA‚Aos Case Management System known as Coordination of Community Services. The Program Manager will report to ... vendor is performing according to the contract scope and providing utilization reviews and quarterly audits to ensure that the State pays only for services that are reasonable and necessary based on what has been approved ...
3/31/2022 Case Manager Admissions ‚Äì Lehigh Valley Health Network ‚Äì Allentown, PA ... utilization review experience. and- 2 years Knowledge of utilization management as it relates to third party payers.Experience ‚Ai Preferred:- 3 years of experience in acute care and- 5 years of experience in case management and DC planning experience within the last 5 years.Knowledge, Skills, and Abilities ‚Ai Required:- Ability to maintain the strictest adherence to HIPAA while maintaining confidentiality of all PHI.- Ability to work in a team ...
3/29/2022 Intake LVN – Licensed Vocational Nurse – Addiction Medicine Services – Hemet, CA Hemet Valley Recovery Center is currently seeking a per diem Intake LVN for our Admissions and Assessment Department.If selected, you will receive a $1,500 SIGN-ON BONUS!!!Qualifications:· Possession of current LVN license· Minimum of 2 years of clinical experience in substance abuse, acute care, and/or psychiatric setting preferred· Admission, triage, and utilization review and/or case management experience preferred· BLS certificationJob Description:· Gathers required demographic and ...
2/9/2022 Registered Nurse / Occupational Health & Wellness ... group medical insurance planJob Description:- 3 Days Onsite and 2 Days Remote- Position Title: Occupational Health Nurse (RN)/Disability Case Management- Colleague Wellness clinic at Pharmaceutical's New York Headquarters- Full time Contractor position (5 ... Minimum of 3-5 years relevant experience in disability/absentee management, utilization review and/or quality assurance (preferable)- Experience in acute episodic care, wellness care and counseling of adults- Proficiency in use of electronic medical record ...
1/19/2022 Clinical Nurse Manager- Hazlehurst Wound Care Center – Innovative Healing Systems – Hazlehurst, GA ... case management. Provides leadership by working cooperatively with ancillary departments and other patient team personnel in maintaining standards for professional nursing practice in the clinical setting. Oversees staffing, training, and is a liaison with physicians, hospital personnel and departments. Is responsible for the utilization of advanced modalities and hyperbaric medicine through compliant administration of case management and utilization review, Performance Improvement initiatives, chart reviews and audits.Drives advanced modalities through ...
1/12/2022 Coder ... Case Management on a daily basis for assistance with utilization review, length of stay and DRG.7. Responsible to maintain 95% accuracy.8. Assist with clinical pertinence collection of data as needed.9. Refers to the Health Information Management Director any issues of quality that may arise in the medical record.10. Keeps informed of changes of guidelines by reviewing coding newsletters and attending seminars.11. Interacts with Admitting Department ...
1/11/2022 CASE MGR, UTILIZATION REVIEW ‚Äì Broward Health Corporate ‚Äì Fort Lauderdale, FL ... patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including:- Utilization Management supporting medical necessity and denial prevention- Transition ... and other duties as assigned.Two years‚Ao acute hospital Utilization Review experience. BSN preferred. Certified Case Manager (CCM) or (ACM) Accredited Case Manager preferred.Active Registered Nurse in the state of Florida/multi-state ...
12/29/2021 Case Management Assistant ‚Äì St. Luke's Health System ‚Äì Jerome, ID St. Luke‚Aos Health System in Jerome is seeking a Case Management Assistant to join our Case Management team.The Case Management Assistant is responsible for providing accurate and timely administrative and technical support to the case and/or utilization management teams, helping ensure a positive patient experience and effective coordination of care and utilization review processes.Responsibilities:- Provides support to the RN Case Managers, Social Workers and Utilization Reviewers ...
12/8/2021 Authorizations Coordinator- ABA Therapy (Remote) – Stride Autism Centers – Chicago, IL ... utilization review or case management departments.-Work assigned accounts-Enter both pending and official prior auth responses in all required Stride systems-Adhere to Stride policy and procedures for completing reports, forms, and office paperwork-Reports to supervisor and/or manager any problems or issues that result in non-approval trends-Inputs client insurance or funding source information, pending prior auth information, treatment plan information, proposed mins for treatment, office ...
8/26/2021 Registered Nurse - Case Manager Registered Nurse ‚Ai Case Management- Case Manager - Travel - (CM RN) Travel/Contract RN/Case Mgr job in Fremont, California with American Mobile Healthcare Job Description & Requirements Registered Nurse ‚Ai Case Management- Case Manager - (CM RN ... D Pay Ra... https://www.nurserecruiter.com/job/jvknz6 RN-Case Management (Utilization Review) Travel/Contract RN/Case Mgr job in Bakersfield, California with Talent4health LLC Talent4health is seeking a RN-Case Management (Utilization Review)‚Au contract ...
7/22/2021 I‚Äôm tired of being a bedside nurse... ... case management or utilization review. You don‚Aot need an advanced degree for that. I have put a lot of time and money into my education and really want to use it. Please don‚Aot be rude to me. I‚Aom only looking for options and advice. What is something I can look for to find a job where I can use my degrees? I have my own business and ...
7/22/2021 Hospital shortage, appraisal district and more discussed during hospital district meeting ... case management for clients. According to BBRHD Executive Director J.D. Newsom, this person would ‚Aumanage hospital systems and give clients a higher level of support.‚Au Although he wanted to keep the identity of the candidate confidential, Newsom said the individual had worked at Humana for 13 years, doing utilization review for the health insurance company. Currently, she works at the hospital as an RN case manager. During the discussion ...
7/22/2021 Clinical Product Support Analyst ‚Äì Change Healthcare ‚Äì Wyoming ... healthcare related field Business Experience ‚Ai - Minimum of five years practical clinical experience; preferably in an acute care setting - Prior case management, software, or support experience - Strong diagnostic and troubleshooting skills - Positive, proactive, customer service ... techniques for obtaining solutions. Preferred Qualifications: - Strong knowledge of HealthCare, utilization review, and case management products and concepts. - Understanding of the interrelationship of Information Technology and Healthcare industries - Knowledge of the Payer/Provider environment - Knowledge ...
7/6/2021 Head of Medical Operations- MBBS at HRLeverage Job Field Medical / HealthcareEnsure that the unit meets its operational objectives as it relates to providers satisfaction, prompt payment of claims and medical utilization managementSupervise the Unit Lead, Claims and Unit Lead, Provider/Case ManagementResponsible and accountable to Management through the Head of Medical Operations.SPECIFICS Supervise and manage day-to-day itinerary of Case Managers Supervise and manage the day-to-day Case Management activities, utilization ...
7/3/2021 Contrasting CorVel (NASDAQ:CRVL) & Waterdrop (NYSE:WDH) ... utilization review, facility claim review, professional review, pharmacy services, directed care services, Medicare solutions, clearinghouse services, independent medical examinations, and inpatient medical bill review. It also provides a range of patient management services, such as claims management, case management, 24/7 nurse triage, utilization management, vocational rehabilitation, and life care planning, as well as processing of claims for self-insured payors with respect to property and casualty insurance. The company was ...
6/28/2021 CorVel (NASDAQ:CRVL) & Waterdrop (NYSE:WDH) Head-To-Head Review Mayfield Recorder ... utilization review, facility claim review, professional review, pharmacy services, directed care services, Medicare solutions, clearinghouse services, independent medical examinations, and inpatient medical bill review. It also provides a range of patient management services, such as claims management, case management, 24/7 nurse triage, utilization management, vocational rehabilitation, and life care planning, as well as processing of claims for self-insured payors with respect to property and casualty insurance. The company was ...
6/28/2021 Waterdrop (NYSE:WDH) and CorVel (NASDAQ:CRVL) Head to Head Survey ... utilization review, facility claim review, professional review, pharmacy services, directed care services, Medicare solutions, clearinghouse services, independent medical examinations, and inpatient medical bill review. It also provides a range of patient management services, such as claims management, case management, 24/7 nurse triage, utilization management, vocational rehabilitation, and life care planning, as well as processing of claims for self-insured payors with respect to property and casualty insurance. The company was ...
5/11/2021 Social Worker (Full-Time & Per Diem) ... case management and maintains communication with the treatment team, families, and referral sources. Provide crisis intervention and risk assessment as needed. May perform assessments, screenings, and intakes, with patients as required. May perform utilization review as needed Multi-lingual counselors may be asked to conduct services in multiple languages to meet the needs of the clients and families Attends all required staff training sessions in accordance with Phoenix House and ...
5/3/2021 Aetna's Threats to Fire Doctors Who Referred Patients to Out-of-network is Legal? May 3, 2021 at 12:52 pmI have spent the better part of 20 years in Case Management and Utilization Review at a smaller hospital. We used agency hospitalists. They were never in network. For some of the managed plans, our hospital is not in network. Closest hospital is 40 miles away and also not in network. That leaves 90+ miles to a facility that might be in network. Some ...
4/27/2021 Medical Management Coordinator ... of this position is to provide efficient and appropriate care management and customer service to Affinity Members and Providers through utilization review, response to Member and Provider inquiries, and phone and mail outreach in support ... policy and Medical Management policy to appropriately direct requests for Case Management or Medical Director Review. Manages standing referrals based on Department and Corporate Medical policy and procedures. Administers the department processes associated with the ...
3/24/2021 Mitchell Genex Coventry launches new specialty business | Business Insurance ... case management, utilization review and 24-hour nurse triage, among other services. Mitchell/Genex acquires managed care services firm Mitchell/Genex to acquire Coventry Workers Comp Mitchell/Genex finalizes acquisition of Coventry Mitchell launches claims analysis tool Scrutinize prescriptions, monitor drug claims: Mitchell 1. OSHA taking ‚Aotime‚Ao on emergency COVID-19 standard 2. Ice cream manufacturer cited after two workers lose fingers 3. More states weigh privatizing comp funds ...
3/16/2021 Pay for utilization review case manager Do you have any insight on how to land a utilization review job? 0 Likes Specializes in Physiology, CM consulting, nsg ED, LNC. Has 51 years experience. 44 minutes agoI had a job like ... the hospital discharge planners (they didn't meet the criteria for case management and were not CCM certified) because we were paid by the medical practice. I got the idea it was more, though. 0 Likes ...
3/14/2021 Nurse Director Case Management Job Opening in Palo Alto, California - California Technology Council ... California, United States 19 hours ago Apply NowDescription An excellent opportunity is now available for a Nurse Director of Case Management at a San Francisco Bay Area Medical Center. The Nurse Director of Care ... team, and will report directly to the Chief Nursing Officer.The Utilization Review Nurse Executive will be responsible and accountable for unit systems functions, staff performance, and patient care outcomes. The RN Director of Case Management ...
3/12/2021 Hospital Social Work Manager Job Opening in Hemet, California - California Technology Council ... Case Management, Utilization Review, and Social Work. The Hospital Social Work Manager will be responsible for staff assessment, daily operations, and will act as the liaison between Case Management, Coding, Compliance, Information Systems, and other departments. To maximize success in this role, the Hospital Social Work Manager will demonstrate the ability to coordinate the integration of social services into patient care as appropriate and foster a collaborative work environment. This ...
2/12/2021 Utilization Review Behavioral Health Care Advocate - Telecommute - UnitedHealth Group - Las Vegas, NV Utilization Review Behavioral Health Care Advocate - Telecommute Utilization Review Behavioral Health Care Advocate - Telecommute UnitedHealth Group Las Vegas, Nevada, United States less than an hour ago Apply NowDescription You have high standards. So do ... Triage Care Advocate Provider Line you will be responsible for case management and utilization review of behavioral health and substance abuse cases. You'll have a direct impact on the lives of our members as you ...