- Tenethealth (Detroit, MI)
- …transition plan, e) leading and/or facilitating multi-disciplinary patient care conferences including Complex Case Review , f) making appropriate referrals to ... at hospital and department orientation is required. Department orientation includes review and instruction regarding Tenet Case Management and Compliance… more
- PharmaCord (Jeffersonville, IN)
- …contributing to the overall success of your program. When you join the team as the Case Manager, you'll have the opportunity to make a difference in the lives of our ... navigate the tricky process to getting access to their complex medication. You'll compassionately deliver an exceptional experience to...focusing on the accuracy of the details of their medical records and your mastery of the program requirements,… more
- Monster (Allentown, PA)
- …case resolution, and impact on revenue and trending. Coordinates RAC appeals for complex case reviews for medical necessity, including determining if ... for Medical Necessity and Late-Pick-Up/Notification that are entered by Case Management and Business Office. Monitors retro denials to ensure resolution within… more
- Rebekah Childrens Service (Gilroy, CA)
- …and Employment Benefits: Competitive Salary 401K matching plan 7.5% Bilingual Stipend Excellent Medical Benefits Up to 5 weeks of combined PTO and Sick Time accrual ... group, and family therapy as well as crisis and case management to clients ages 6-21 and their families....client charts in compliance with requirements of Phase II Medical Consolidation (Title 9, Chapter 11, Section 1810.440). Demonstrates… more
- Health eCareers (Oak Lawn, IL)
- …practice (arterial lines, central lines, regional anesthesia, neuraxial anesthesia) Diverse Case Variety: Ranges from simple to complex , including general ... to live well. We're currently seeking general anesthesiologists to join our physician-led medical group at Advocate Christ Medical Center in Oak Lawn,… more
- Veterans Benefits Administration (Colorado Springs, CO)
- …before submitting invoices to Finance Division for payment. Provides case management services including coordination of all rehabilitation services, employment ... services, documentation of progress and adjustment, and maintenance of case records according to VA regulations. Act as Contracting Officer's Technical… more
- Monster (Merrifield, VA)
- …key performance indicators and establish processes and methodologies for preventative mitigation ( Complex analysis). Compile, review and prepare data to be used ... practices in broad areas of assignments and relates fields. Works on the most complex , high impact projects. Serves as a technical specialist or advisor to the IAM… more
- Inside Higher Ed (Denver, CO)
- …university's primary liaison with the City of Denver police, fire, emergency medical services, and emergency preparedness departments, as well as with other external ... maintains sufficient knowledge of federal, state, and local laws, case law, and regulations relating to campus safety and...chief campus safety officer will be expected to manage complex situations and staffing; role model a sincere and… more
- Health eCareers (St. Charles, MO)
- …education regarding proper documentation practices that present potential liability problems.Performs medical record review for the purpose of identification of ... and provides reports to legal counsel to assist in preparation of defense.Completes case summaries on all medical malpractice and general liability cases and… more
- Monster (Huntsville, AL)
- …correspondence including pleadings, discover, motions, orders, and notices. Schedule and maintain case calendars Research complex issues using Westlaw or Lexis ... and case law cite checks. File pleadings, motions, and other documents. Review and summarize depositions, medical records, and other documents. What you… more
- Monster (Salt Lake City, UT)
- …exceptional patient-centered care for a targeted population of individuals with complex medical and psychosocial needs. Providing comprehensive and integrated ... illness, and health maintenance* Collaborate with interdisciplinary team (social workers, medical assistants, case workers, nurses)* Supervise 1-2 Advanced… more
- APTIM (Santa Fe, NM)
- **Summary:** The Senior-Level Claims Reviewer is responsible for independently reviewing, analyzing, and processing complex claims related to disaster losses in ... on claims interpretation, policy compliance, and documentation quality. The Senior Reviewer also supports mentoring of mid-level staff, provides guidance on… more
- Veterans Affairs, Veterans Health Administration (Martinsburg, WV)
- …well as customer service programs. Responsibilities The Risk Manager Clinical Reviewer (RMCR) Registered Nurse (RN) is responsible for providing competent, ... Performs clinical reviews for Occurrence Screens and/or Tort Claims and recommends Peer Review when quality of care issues are recognized. Prepares the Peer … more
- APTIM (Santa Fe, NM)
- **Summary:** The Mid-Level Claims Reviewer supports the claims process by reviewing, evaluating, and documenting claims for disaster-related losses. This role ... needed. **Key Responsibilities/Accountabilities:** + Ability to understand and interpret complex federal policy language, including relevant statutes, regulations, policies,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …conjunction with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or ... appropriate cases to the Medical Director for review . Refer to and work closely with Case...in improving member and community health. + Manages more complex assignments; cross-trained to review various levels… more
- The Cigna Group (Bloomfield, CT)
- …is responsible for the following: + Laboratory molecular and genetic testing clinical case review activities. + Evaluate telephone, fax, or web requests for ... coverage of services or referring requests for expert clinical review as appropriate. + Be available as an expert...Strong interpersonal skills with the ability to clearly explain complex medical information in both verbal and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: RN Specialist Complex Case Manager - Oncology Location: Remote Career Area: Health ... * Receives referral for member identified with high cost, complex medical conditions and telephonically outreaches to...to the member, family and providers to engage in complex case management program. * Conducts clinical… more
- Henry Ford Health System (Detroit, MI)
- …with computers, electronic health records (EHR), database systems, and utilization review / case management documentation systems. + Knowledge of CMS, commercial ... sign on bonus available for qualified experienced candidates with current 2 years RN Case Management in a large acute care hospital setting. GENERAL SUMMARY: The … more
- Henry Ford Health System (Detroit, MI)
- …of computers, Electronic Health Records, data base systems and utilization review / case management documentation systems. Desire to work collaboratively and ... for qualified experienced candidates with current 2 years MSW Case Management in a large acute care hospital setting....of services - from primary and preventative care to complex and specialty care, health insurance, a full suite… more
- Commonwealth Care Alliance (Boston, MA)
- …access clinical specialty panel physicians to assist in complex or difficult case + Ensure compliance with medical policy. Maintains compliance with all ... Director of Medical Policy and Utilization Review , the Utilization Review Medical ...issues with attending physicians and CCA clinicians + Document case review findings, actions, and outcomes in… more
