- Actalent (Fort Lauderdale, FL)
- Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary ... review Utilization management InterQual Milliman Commercial Guidelines Medicaid Medical management Medicare Managed care Patient care Medical record Case … more
- UnitedHealth Group (Brooklyn, NY)
- …HCPC codes Knowledge of clinical standards of care Awareness NCQA requirements, CMS guidelines, Medicaid/ Medicare contracts and benefit systems Compensation for ... of the Optum family of businesses, is seeking a Nurse Practitioner or Physician Assistant to join our team...newly enrolled members and bi-annually thereafter. Develops a member management care plan upon enrolment and updates it as… more
- University of Maryland Medical System (La Plata, MD)
- …Regional? Commitment to Excellence - Recognized as a 4-star hospital by the Centers for Medicare and Medicaid Services ( CMS ) and honored with the Get With The ... Company Description Licensed Practical Nurse (LPN) - Emergency Department (ED) Full-time /...a proud member of the University of Maryland Medical System , where we combine the resources of a top-tier… more
- Seattle Children's Hospital (Seattle, WA)
- …Unit As per the College of American Pathologists (CAP) and the Centers for Medicare and Medicaid Services ( CMS ), for nurses performing moderately complex point ... Registered Nurse - NICU (0.9 FTE, night shift) *Sign...use of inhaled nitric oxide, etc. The NICU charge nurse responds to all Code Blue events in the… more
- Healogics (Madison, TN)
- …accrediting organizations, federal and state regulation, and to the Centers for Medicare and Medicaid Services ( CMS ) guidelines, as applicable. Essential ... out-patient clinic partnerships Under the direction of a Registered Nurse (RN) or Provider, the Wound Care Center Licensed...with intake and discharge. May provide assistance with case management under the direction of RN, in accordance with… more
- Healogics (La Grange, KY)
- …accrediting organizations, federal and state regulation, and to the Centers for Medicare and Medicaid Services ( CMS ) guidelines, as applicable. Essential ... benefit through our out-patient clinic partnerships The Clinical Coordinator (CC)/Clinical Nurse Manager (CNM) is responsible for the coordination of clinical… more
- ISNP (Portland, OR)
- …testament to our model's success but the efforts, care, and commitment of our Nurse Practitioners. Serving millions of Medicare and Medicaid patients, Optum is ... manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services ( CMS ) regulations Responsible for ensuring… more
- Curana Health, Inc. (Leesburg, VA)
- … CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans). With rapid year-over-year growth since our founding in ... clinical needs, many of whom have been historically underserved by the healthcare system . Our mission: To radically improve the health, happiness and dignity of… more
- UnitedHealth Group (Centralia, WA)
- …knowledge of clinical standards of care Demonstrated awareness of NCQA requirements, CMS guidelines, Medicaid/ Medicare contracts and benefit systems The hourly ... days a week Optum is seeking a Part Time Nurse Practitioner to join our Home-based Medical Care team...visits to address changes in condition Develops a patient management care plan upon enrollment and updates it as… more
- Healogics (Edinburg, TX)
- …accrediting organizations, federal and state regulation, and to the Centers for Medicare and Medicaid Services ( CMS ) guidelines, as applicable. Essential ... benefit through our out-patient clinic partnerships The Clinical Coordinator (CC)/Clinical Nurse Manager (CNM) is responsible for the coordination of clinical… more
- CentraState Healthcare System (Freehold, NJ)
- …State, and other regulatory agency rules and regulations including The Joint Commission, CMS , Medicare , including but not limited to, knowledge of CMS ... Overview Emergency Department (ED) Nurse Care Manager is responsible for establishing, coordinating,...rules regarding Observation status, the 2 Midnight Rule, and Medicare Inpatient Only Procedures. Maintains knowledge of continuum of… more
- Accel Rehabilitation Hospital of Plano (Plano, TX)
- …and timely data to the appropriate entities involved in the Prospective Payment System (PPS) and quality reporting program for Medicare patients. *Oversees all ... and acts as the primary resource for immediate problem solving in regard to Medicare 's IRF prospective payment system (GG scoring, impairment group coding, tier… more
- Healogics (Coquille, OR)
- …to accrediting organizations, federal and state regulation, and to the Centers for Medicare and Medicaid Services ( CMS ) guidelines, as applicable. Weekday days ... clinic partnerships Under the direction of the Wound Care Center Clinical Nurse Manager/Clinical Coordinator, the Registered Nurse (RN) primarily provides… more
- UnitedHealth Group (Pasco, WA)
- …manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services ( CMS ) regulations. Responsible for ensuring ... and navigate care anytime and anywhere. Serving millions of Medicare and Medicaid patients, Optum is the nation's largest...be interested in. Required Qualifications: For NPs - Certified Nurse Practitioner through a national board Graduate of an… more
- Regal Medical Group, Inc. (Northridge, CA)
- …compliance with all health plan, state, and federal regulatory requirements (eg, DMHC, Medicaid, CMS Medicare Part C & D, NCQA where applicable) to prior ... Prior Authorization Clinical RN is to manage the prior authorization nurse case managers and support staff (coordinators), professional claims review nurses… more
- UnitedHealth Group (Mount Vernon, WA)
- …knowledge of clinical standards of care Demonstrated awareness of NCQA requirements, CMS guidelines, Medicaid/ Medicare contracts and benefit systems The hourly ... days a week Optum is seeking a Part Time Nurse Practitioner to join our Home-based Medical Care team...visits to address changes in condition Develops a patient management care plan upon enrollment and updates it as… more
- Greenlife Healthcare Staffing (Troy, MI)
- …holidays Employee discounts Employee retirement plan (401k) Company-paid life insurance CMS 's Long-Term Care Basic Training and SMQT certification are required ... Specific activities include the following: Conduct on-site surveys of Medicare -Medicaid certified health care facilities to determine compliance with Federal… more
- Providence Health & Services (Fortuna, CA)
- …committed to delivering top-notch healthcare, earning a 5-star rating from the Center for Medicare and Medicaid Services ( CMS ) as well as a Top Performing ... Health Clinic is responsible to assist the physician, physician assistant or nurse practitioner in providing patient care while demonstrating our core values. The… more
- BG Consulting Services LLC (Bethesda, MD)
- …Virtual Analyst, M2 Data Mart, EDW, Population Health Operational Tracking and Optimization System , DMLSS, CMS , CAC Enabled Protocol Website, Medical Expense and ... to include DoD Tri-Service Military Healthcare Systems, TRICARE purchased care system , Medicare , Medicaid, VA, Public Health Department, and Regional… more
- CenterWell Primary Care (Decatur, GA)
- …review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. Competently ... Valid driver's license, auto insurance and reliable transportation. Two years as a Registered Nurse with at least one-year of management experience in a home… more
