- Excellus BlueCross BlueShield (Rochester, NY)
- …by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address ... Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise interacts… more
- Sutter Health (Sacramento, CA)
- …Sutter Health! **Organization:** SHSO-Sutter Health System Office-Valley **Position Overview:** The Physician Advisor (PA) is a key member of the hospital's ... care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity,… more
- CareOregon (Portland, OR)
- …non-dominant groups within Housecall Providers and our communities at large. The quadruple aim is real at Housecall Providers In home medical care for homebound ... on the satisfactory completion of a pre-employment background check, immunization review , and drug screen (including THC/Marijuana). CareOregon is a federal… more
- Sutter Health (San Francisco, CA)
- …Planning and Utilization Management throughout the acute care patient experience. The RN Case Manager works in collaboration with the Physician , Medical Social ... CPMC-California Pacific Med Center Van Ness **Position Overview:** The RN Case Manager is responsible for Care Coordination, Care Transitions, Discharge… more
- Access Dubuque (Dubuque, IA)
- …is also available remotely within Iowa. **Key Responsibilities:** + Provide telephonic case management and utilization review for assigned consumers. + Develop, ... preferred. + **Experience:** Minimum 2 years of clinical practice. Case management or utilization review experience strongly...life's toughest moments. To deliver on that promise, we aim to hire, train, and grow the best professionals… more
- Banner Health (Gilbert, AZ)
- …provider networks, and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through ... **Primary City/State:** Gilbert, Arizona **Department Name:** Case Mgmt-Hosp **Work Shift:** Day **Job Category:** Clinical Care Nursing careers are better at Banner… more
- Sutter Health (Emeryville, CA)
- …Sutter Health! **Organization:** SHSO-Sutter Health System Office-Bay **Position Overview:** The Physician Advisor (PA) is a key member of the hospital's leadership ... care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity,… more
- CareOregon (Portland, OR)
- …non-dominant groups within Housecall Providers and our communities at large. The quadruple aim is real at Housecall Providers In home medical care for homebound ... on the satisfactory completion of a pre-employment background check, immunization review , and drug screen (including THC/Marijuana). CareOregon is a federal… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …case reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on ARD cases, ... and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides input into...of Medicine or Doctor of Osteopathic Medicine. + The Physician is not the subject of any pending professional… more
- ChenMed (Largo, FL)
- …patient's primary care physician to meet urgent patient needed with the aim of preventing unnecessary hospital arrivals + Performs other duties as assigned and ... other members of the care team that provides hyperfocus case management and field nursing interventions to prevent unnecessary...episode of care management the register nurse (RN) will review patient chart for discharge and conduct final discharge… more
- ChenMed (Jacksonville, FL)
- …patient's primary care physician to meet urgent patient needed with the aim of preventing unnecessary hospital arrivals + Performs other duties as assigned and ... episode of care management the register nurse (RN) will review patient chart for discharge and conduct final discharge...may need and to oversee appropriate patient discharge from case management. + Performs clinical, fall prevention, and social… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , quality assurance, ... + Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Oversees the activities… more
- Stanford Health Care (Palo Alto, CA)
- …revenue cycle certification- Health Care Quality (HACP, CPHQ, HCQM) certification- Case Management Certification (CCM) or clinical certification- Physician ... experience. + ICU/ED and Academic Medical Center experience preferred. + Case management, utilization review and/or direct provider interaction experience,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …contracts. Essential Primary Responsibilities/Accountabilities: All Levels + Operates as a case advisor for Insureds accessing benefits under their LTC policy as ... standards required by the Company. + Evaluates Insured's condition through review of field assessments, medical records, etc. Determines benefit eligibility based… more
- Banner Health (Mesa, AZ)
- …participate in the interdisciplinary therapy team along with nurses, physicians, and case managers to provide evaluations and delegate tasks to the Physical ... that includes the da Vinci Surgical System. Becker's Hospital Review named Banner Desert Medical Center as one of...50 busiest Emergency departments in the country. If you aim to deliver top-tier care to the most vulnerable… more
- Banner Health (Mesa, AZ)
- …participate in the interdisciplinary team including therapists, nurses, physicians, and case managers to provide direct patient care and recommend appropriate ... that includes the da Vinci Surgical System. Becker's Hospital Review named Banner Desert Medical Center as one of...50 busiest Emergency departments in the country. If you aim to deliver top-tier care to the most vulnerable… more
- Banner Health (Mesa, AZ)
- …participate in the interdisciplinary team including therapists, nurses, physicians, and case managers to provide direct patient care and recommend appropriate ... that includes the da Vinci Surgical System. Becker's Hospital Review named Banner Desert Medical Center as one of...50 busiest Emergency departments in the country. If you aim to deliver top-tier care to the most vulnerable… more
- HCA Healthcare (Cypress, TX)
- …and Nursing staff work as a team in association with the patient's physician , the department Medical Director, and other members of the multidisciplinary team to ... Communicates the patient's condition and/or change to appropriate staff and/or physician , as needed. + Ensure appropriate delivery of cardiopulmonary/patient care… more
- Cleveland Clinic (Cleveland, OH)
- …experience is available at the _Cleveland Clinic Lerner College of Medicine of Case Western Reserve University_ . Board Certification via the American Board of ... Pediatric Institute. Cleveland Clinic Children's and the Center for Pediatric Behavioral Health aim to create an equitable and engaging work environment in which all… more
- Person Centered Services (Batavia, NY)
- …Please provide one to two sentences starting with an action verb, followed by the aim of the position that identifies the primary result of the position. The care ... every time there is a life changing event. This review must occur during a face-to-face meeting, no less...appropriate records. + Completes and reviews paperwork necessary for case files and reports. + Completes documentation and billing… more