- Integrated Home (Hollywood, FL)
- …receive unnecessary procedures, ineffective treatment, or unnecessarily extensive home healthcare. Concurrent review of patient's clinical information for ... the sole intent of providing the highest quality in-home care services that improve and enhance the daily living...situation Provide updates to Manager of Utilization Management for review What will you come with: State licensure as… more
- Inside Higher Ed (Augusta, GA)
- …students - Will actively participate in resident, medical student, and fellow education concurrent with patient care - Meet all core faculty requirements as ... Open Rank- Clinical Faculty in Emergency Medicine Job ID: 275954 Location: Augusta University Full/Part Time: Full Time Regular/Temporary: * Job Summary Job ID… more
- UC Davis Health (Sacramento, CA)
- The Clinical Case Manager integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Clinical ... safe discharge plan. Facilitates the collaborative management of patient care across the continuum, completing utilization review ...as necessary to remove barriers to timely and efficient care delivery and reimbursement. The Clinical Case… more
- BridgeWay Home Health (Atlanta, GA)
- …orders and strives to provide the highest quality of care . The RN Clinical Manager is also responsible for the review of the individual patient medical ... RN Clinical Manager - Home Health - Full Time OASIS pre- review , review and clinical documentation oversight OASIS data assessment tool experience… more
- UnitedHealth Group (Cypress, CA)
- …MCG and/or Medicare criteria 1+ years of Utilization Management, pre-authorization, concurrent review or appeals experience Appeals experience Proven excellent ... At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers...records and verify if the requested service meets criteria Review pre-service appeals for clinical eligibility for… more
- UnitedHealth Group (Eden Prairie, MN)
- …Caring. Connecting. Growing together. The Clinical Performance Quality (CPQ) Clinical Programs Operations team supports Optum's Care Delivery Organizations ... Programs. The Registered Nurse will perform telephonic, patient-centered clinical consults focused on Care for Older...obtain needed evidence of completed lab work, screenings and care provided Review available medical records for… more
- Northwestern Memorial Healthcare (Palos Heights, IL)
- …documentation issues, quality issues, and opportunities for improvement in patient care and services. Basic understanding of clinical documentation through ... departmental and hospital committees and task-forces as assigned. Participates in concurrent performance improvement activities and on-going review activities.… more
- Sea Mar Community Health Centers (Seattle, WA)
- …problems; contract compliance; carrying a small case load of clients to provide direct care . The clinical supervisor must position must hold a certification from ... such as those for infant, adolescent, or geriatric patients. Review and approve clinicians' clinical documentation in...SUD issues alone and those that are complicated by concurrent mental illness. The ability to develop treatment plans… more
- Curative HR LLC (Austin, TX)
- … expert, ensuring appropriate resource utilization, promoting evidence-based care , and fostering positive relationships with practitioners through effective ... to transform health insurance by eliminating financial barriers to care and guiding members at every step of their...processes and improve member outcomes. Contribute to the development, review , and revision of medical policies, clinical … more
- UnitedHealth Group (Lacey, WA)
- …informed decisions. By serving as the link between patients and the appropriate health care personnel, the Clinical Review Coordinator- Onsite is responsible ... Optum Home & Community Care , part of the UnitedHealth Group family of...Perform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and utilizing CMS criteria upon admission to… more
- Orlando Health (Longwood, FL)
- …Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care . ... coordination services to include assessing patients' risk factors and the need for care coordination, clinical utilization management and the transition to the… more
- Alto Health Care Staffing (Stevens Point, WI)
- …related to a patient's therapeutic drug regimen. Communicate and participate in the clinical care of patients; document care provided. Evaluate the ... teaching, medication histories, adverse drug reaction assessment, or drug therapy review . Assure continuity of pharmaceutical care by providing physicians,… 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
- Cumberland Heights Foundation, Inc. (Nashville, TN)
- …payor case managers, to provide the necessary information for concurrent review and benefit authorization for the patient's care , including providing ... toward patient's goals in establishing ongoing recovery management, including review and revision of the plan of care...practices as defined within the Cumberland Heights Model of Care . Documents clinical activities in patient record… more
- RCM Health Care Services (New York, NY)
- …ICD 10, create treatment plan, and implement treatment plan with patients in Primary Care clinic Complete charting in EMR and concurrent documentation as well as ... with a very completive salary and exceptional benefits. Position Title: Licensed Clinical Social Worker Reports to: Director of Mental Health Location: Manhattan Job… more
- CenCal Health (Santa Barbara, CA)
- …for performing utilization management activities, which may include telephonic or onsite clinical reviews, care coordination, transitions of care , or ... and timely prospective (pre-service) reviews for services requiring prior authorization. Perform timely concurrent reviews for inpatient care in acute care ,… more
- Optum (New Berlin, WI)
- …which provides a clinical and psychosocial approach through the continuum of care . Through concurrent case management, patients will be assessed to determine ... opportunities with Optum , in strategic partnership with ProHealth Care . ProHealth Care is proud to...throughout the course of hospitalization in partnership with the clinical team, the patient, and/or the patients representative. Quality… more
- Sonder Health Plans, Inc. (Atlanta, GA)
- … nursing experience *Active Georgia Registered Nursing license *Pre-authorization and Concurrent review experience *Medical record investigative review ... of this position is to provide operational support and clinical expertise in the areas of health care...*Coordinate case management on complex cases that require additional clinical management support *Conducts initial review of… more
- Health eCareers (Franconia, NH)
- …at both State and National levels. Abstracts and organizes data obtained from concurrent and retrospective chart review of thoracic surgery patient subsets. ... Thoracic Surgery (STS) database. Performs outcomes analysis, identifies trends, initiates review and assists with coordination of MWHC quality improvement team… more
- Garden Place Healthcare (Attleboro, MA)
- …Medicare Program are met, such as Physician certification and re-certification. *Performs concurrent MDS review to assure appropriate RUG/PDPM category is ... the state in which employment occurs. *Minimum of two years health care experience. *Experience with MDS completion, reimbursement, clinical resource utilization… more
