- Actalent (Fort Lauderdale, FL)
- …Medicare Managed care Patient care Medical record Case management Concurrent review Discharge planning Medical Acute care Additional Skills & ... Prepare and present reports on department activities as assigned. Essential Skills Clinical review Utilization review Utilization management InterQual… more
- Hackensack Meridian Health (Hackensack, NJ)
- …include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions of care , as outlined in ... j. Develop strategies across all functional departments to reduce clinical denials by: I. Peer-to Peer (P2P) Concurrent...concurrent and retrospective review process. c. Review and facilitate appropriate Level of Care … more
- Signature Healthcare (Brockton, MA)
- …Coding, Physicians, Nursing, Social Work, Quality Department and ancillary staff. Performs concurrent analytical review of the medical record to assure complete ... POSITION SUMMARY: The Utilization Review Specialist - Behavioral Health works collaboratively with...point of entry to discharge. Performs timely utilization and clinical reviews and communicates with insurance/ managed care… more
- Magellan Health, Inc. (San Diego, CA)
- … care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against ... Education - Preferred License and Certifications - Required LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - … more
- Healthier Mississippi People (Jackson, MS)
- …prospective, concurrent , retrospective, and denial management reviews by applying clinical protocols and review medical necessity criteria. Reports quality ... via cable and Windows 10 RESPONSIBILITIES: Performs all aspects of prospective, concurrent , retrospective and denials review for individual cases to include… more
- Arlington County, VA (Arlington, VA)
- …Services Division of the Department of Human Services (DHS) is seeking a Foster Care Social Worker . This position will work with mental health, education, legal, ... and effectiveness of comprehensive services to children and families needing foster care and adoption services. This is a professional position in an integrated… more
- Memorial Hermann Health System (Pearland, TX)
- …needed. Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department. Ensures that all elements critical to ... Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When… more
- Blue Shield of California (San Diego, CA)
- …Behavioral Health (BH) Utilization Management (UM) team manages prior authorization and concurrent review for members seeking mental health and/or substance use ... Requires practical knowledge of Utilization Management functions including prior authorization/ concurrent review Requires a college degree or equivalent… more
- Regal Medical Group, Inc. (Orange, CA)
- …Ability to collaborate and communicate with all members of the healthcare team ( concurrent review , pre-authorization, PCP, SPC, Social Services, and Pharmacy) to ... care , based on the member's input and assessed clinical and non- clinical needs of each member....needs of patients, fostering collaboration and communication among all clinical team members to enhance care provision.… more
- HCA Healthcare (Fort Lauderdale, FL)
- …aid of a computer database consisting of facility service profiles, approved clinical protocols, established patient care protocols, and healthcare information ... assist with the development of an initial plan of care Ensures accurate and concurrent data collection...human growth and development, assessment, range of treatment, and care of patients of all ages and clinical… more
- Catholic Guardian Services (Bronx, NY)
- Post Internal Days 0 Category Family Foster Care Description Catholic Guardian Services Job Description Title: Senior Director of Social Services, Family Foster ... Care Programs Reports to: Assistant Executive Director Major Duties...the early engagement of families and the provision of concurrent planning and aftercare services; and monitors issues associated… more
- Thomas Jefferson University Hospitals, Inc. (Philadelphia, PA)
- …appropriate level of care for acute and post-acute inpatient services. Perform concurrent review and/or admission review on all hospital admissions using ... adult population in the post-acute inpatient setting (ie,SNF/Rehab). Also, responsible to review clinical information provided by facilities and communicates UM… more
- Kaiser Permanente (Decatur, GA)
- … by chart review and discussion with attending physician, admission and concurrent review for inpatient admissions, meetings with patient and families to ... quality review , monitoring for inefficiencies and opportunities to improve care , developing a safe discharge plan to include recommending alternative levels and… more
- Trinity Health (Syracuse, NY)
- …healing presence within our communities. Vision: *To be world-renowned for passionate patient care and outstanding clinical outcomes. Core Values : *In the ... & decisions. Work Focus: Participates in & contributes to the performance management/ review process. Responds promptly & directly to meet or exceed customers' needs.… more
- Trinity Health (Athens, GA)
- …Knowledgeable of Medicare, Medicaid and non-governmental payer regulations for patient care requirements. Timely completion of initial and concurrent reviews, ... hospital setting and to ensure patients progress along the continuum of care . RN CM facilitates patient transitions efficiently and in a cost-effective manner… more
- Protouch Staffing (Hickory, NC)
- … clinical social work and best practice in medical necessity determination and concurrent review . Accountable for the execution, adaptation and outcome of ... care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of ...Review Plan with regard to resources, appropriateness of care and adherence to a designated Geometric Length of… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …and committee participation. The Medical Director of Behavioral Health oversees the inpatient/ concurrent review process, care integration efforts, and all ... services, medication management, and coordination of behavioral health services and primary care . Provides direction of current clinical practices for behavioral… more
- Amberwell Health (Atchison, KS)
- …Concurrently and retrospectively reviews patient medical record utilizing specific medical care review criteria to assure proper utilization of hospital ... and are so documented in patient's medical records. Performs on-site and/or telephonic concurrent review of acute, Observation and Swingbed services, as well as… more
- Landmark Medical Center (Woonsocket, RI)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... award-winning team! Landmark Medical Center is a 214-bed acute care hospital in Woonsocket, RI. The hospital has been...of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred. Five… more
- Northwell Health (Mount Kisco, NY)
- …- planning, assessing, implementing and evaluating patient in collaboration with the health care team. Conducts chart review for appropriateness of admission and ... the patient and facility/physician. Ensures a continuum of quality patient care throughout hospitalization and oversees provisions for patient's discharge. Assesses,… more
