- Elevance Health (Chicago, IL)
- …a team of clinical operations managers who will perform clinical reviews for a set of Post Acute Care Utilization Management solutions and complex cases ... or a UM/benefits management firm - Utilization management or clinical experience with post - acute care , especially wound care -Certified Wound care … more
- Elevance Health (Walnut Creek, CA)
- …+ CA, PALO ALTO **Description** **Clinical Operations Associate Medical Director** **Carelon Insights** ** Post Acute Care Utilization Review** Schedule: ... for payment as part of consideration for employment. **Associate Medical Director - Post Acute Care ** + Job Family: MED > Licensed Physician/Doctor/Dentist +… more
- Sutter Health (San Francisco, CA)
- …trending. * Directs and oversees the Case Management Assistants to determine preferences for post - acute care services. Utilization Management. * Reviews ... in order to avoid unnecessary admissions, improper level of care utilization , and delays in transition. Reviews...Manual, CDPH and TJC. A broad knowledge base of post - acute levels of care and… more
- Sutter Health (San Mateo, CA)
- …This position coordinates the utilization management, resource management, discharge planning, post - acute care referrals and care facilitation. This ... to interview patient/family and determine preferences for post - acute care services. Utilization Management. * Completes initial InterQual review… more
- Conviva (San Antonio, TX)
- …for managing populations and coordinating care to reduce acute and post - acute care utilization . The Manager role is hybrid with travel ... data analytics, and create action plans that will reduce acute and post - acute care utilization . * Solicits/shares feedback with market leaders on… more
- Logan Health (Conrad, MT)
- …government programs and commercial payers. + Works across the LH system focusing on post - acute care utilization , reduction of unnecessary hospital ... service objectives, policies and procedures. Collaborates with leadership on care management, business strategy, business development, implementation and execution.… more
- Kaleida Health (Buffalo, NY)
- …leadership and guidance for critical areas of Care Management (CM), Discharge Planning and Post - Acute Care Transitions. The VP will oversee the Care ... internal equity, and any applicable collective bargaining agreement.* **Grade:** 600 **Position:** VP Care Management Post - Acute Care Transition **Union… more
- Elevance Health (Columbus, OH)
- …Carelon Medical Benefits Management is looking to hire a **National Medical Director Post Acute Care Solutions** . This high-performing individual ... Medicine, Business Strategy, Product Strategy. + Experience with Managed Care , Utilization Management, Prior Auth, and Benefits...and Benefits Management decision support in the Post - Acute Domain, DME, Home Health, and Wound Care… more
- Good Samaritan Society (Olathe, KS)
- …100 years of housing and services to seniors with a commitment to quality care and service in a Christian environment.** **Facility:** GSS KS Olathe Hoeger House ... with the primary role of enriching the lives of all patients under our care . * Direct access to your earnings daily * Flexible Scheduling Options Available *… more
- LA Care Health Plan (Los Angeles, CA)
- …Provides the primary clinical point of contact for inpatient acute care hospitals requesting Inpatient care / post -stabilization admission requests, Higher ... the inpatient care team for facilitation/coordination of patient transfers between acute care facilities. Acts as a department resource for medical service… more
- UNC Health Care (Chapel Hill, NC)
- …care providers, and payors), and assesses the patient care progression from acute care episode through post discharge for quality, efficiency, and ... effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure patient needs are met and care delivery is… more
- Providence (Napa, CA)
- …planning, or utilization management experience in the acute , sub- acute , home health setting or managed care environment. **Preferred qualifications:** + ... . The RN Case Manager assists patients in the utilization of appropriate health care services. Position...clinical experience with 2 years clinical experience in an acute care hospital setting, or + 1… more
- ChenMed (Louisville, KY)
- …on a expeditious discharge planning to next level of care . The acute care nurse will anticipate the need for post - acute and/or long-Term care , ... Nurse when patient is discharged to home and/or from post - acute care facilities. The ...patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff… more
- Ventura County (Ventura, CA)
- …have at least five (5) years of full-time professional registered nursing experience in an acute care setting? You MUST list this experience and enter all the ... health care facilities; responsible for complying with AB 1203, Post Stabilization notification; and complies with other duties as described. The incumbent… more
- LA Care Health Plan (Los Angeles, CA)
- …Experience Required: At least 5 years of varied clinical experience in an acute hospital setting. At least 2 years Utilization Management/Case Management ... Preferred: Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care Management (CM). Knowledge of Department… more
- Beth Israel Lahey Health (Burlington, MA)
- …of the healthcare team to coordinate and facilitate patient discharge. 14) Works with the Post Acute Care Coordinator to facilitate timely patient access to ... Registered Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review, discharge planning...post acute care Services. 15) Participates in hospital… more
- Providence (Seattle, WA)
- …and administrative ability documented + 5 years of experience in a clinical or acute care setting which includes understanding and delivery of evidence based ... URAC (preferred) + Knowledge of principles and practice of acute utilization management + Knowledge of evidence-based...+ Understanding of the care continuum and care transitions related to acute care… more
- Actalent (San Bernardino, CA)
- …acute inpatient stay and post - acute facility stay. The Utilization Review RN Coordinates continuing care /outside services for value based risk members ... Utilization Review RN is a member of the Care Coordination team. The goal of care ...California RN License BLS AHA Must be experienced with Care Management Prior Authorizations Acute Outpatient experience… more
- Munson Healthcare (Traverse City, MI)
- …current on all regulatory changes that affect medical necessity or reimbursement of acute care services and shares that information with program colleagues and ... Refers cases to the Physician Advisor when documentation is inadequate to support acute level of care and remains unresolved after discussing with… more
- Martin's Point Health Care (Portland, ME)
- …This collaboration includes timely communications with in and out of network hospitals, post - acute care facilities, other providers, and internal departments ... preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care ...+ Utilization management experience in a managed care or hospital environment required + Certification in managed… more