- CVS Health (Columbus, OH)
- …it all with heart, each and every day. **Position Summary** The Care Plan Reviewer (Clinical Case Manager BH) utilizes advanced clinical judgment and critical ... Independent clinical license preferred: LPCC, IMFT, or LISW + Managed care/utilization review experience + Case management and discharge planning experience… more
- St. George Tanaq Corporation (Lansing, MI)
- …Experience and Skills** + One (1) year of Medicare appeals, medical review , clinical, healthcare regulatory interpretation/application, healthcare compliance or ... university in healthcare or related discipline Additional experience in Medicare appeals, medical review , clinical, or other related experience in a healthcare… more
- St. George Tanaq Corporation (Phoenix, AZ)
- …+ Must have 2-3 years of medical dispute resolution or Medicare appeals, medical review , clinical, or related experience in a healthcare setting + Must have ... US Eastern, Central or Mountain Time Zones. **Responsibilities** + Reviews medical records/ case file, writes a reconsideration/dispute resolution decision that… more
- The Cigna Group (Bloomfield, CT)
- …is responsible for the following: + Laboratory molecular and genetic testing clinical case review activities. + Evaluate telephone, fax, or web requests for ... coverage of services or referring requests for expert clinical review as appropriate. + Be available as an expert...Strong interpersonal skills with the ability to clearly explain complex medical information in both verbal and… more
- Penn Medicine (Lancaster, PA)
- …of challenges and barriers to discharge including; mental health concerns, high cost medical care, complex medical needs, criminal history, housing ... the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and...Case Manager to join a team of dedicated Case Managers managing a variety complex cases.… more
- Henry Ford Health System (Detroit, MI)
- …with computers, electronic health records (EHR), database systems, and utilization review / case management documentation systems. + Knowledge of CMS, commercial ... sign on bonus available for qualified experienced candidates with current 2 years RN Case Management in a large acute care hospital setting. GENERAL SUMMARY: The … more
- Commonwealth Care Alliance (Boston, MA)
- …access clinical specialty panel physicians to assist in complex or difficult case + Ensure compliance with medical policy. Maintains compliance with all ... Director of Medical Policy and Utilization Review , the Utilization Review Medical ...issues with attending physicians and CCA clinicians + Document case review findings, actions, and outcomes in… more
- Covenant Health (Nashua, NH)
- …+ Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all mandatory learning assignments ... Summary Conducts medical necessity reviews in accordance with the Utilization...team. + Annual goals are achieved. + Attends pertinent case management/utilization review programs to maintain current… more
- McLaren Health Care (Petoskey, MI)
- …for new supplies and minor equipment purchases. + Fosters smoothly running case management and utilization review services and processes through timely ... attainment of objectives through the selection, development, training, and evaluation of case management and utilization review services staff. + Maintains… more
- Price Benowitz LLP (Washington, DC)
- …team. Job Summary Price Benowitz, LLP is looking to add a full-time Personal Injury Medical Case Manager to join its growing team at its Washington, DC ... headquarters. You will coordinate medical case management efforts across our department,...and support to legal team members as needed. + Review and analyze clients' medical records and… more
- Select Medical (Madison, WI)
- …respiratory therapist or master's in social work and minimum three (3) years of medical case management or similar experience._** **Previous case mangement ( ... discharge planning ) experience with medically complex patients in a hospital critical care setting and...a related discipline. + Minimum three (3) years of medical case management or similar experience. +… more
- UNC Health Care (Raleigh, NC)
- …the unique communities we serve. **Our Case Management team is seeking a System-wide Complex Case Manager to provide support to a network of 6 owned and 10 ... teams + Provide warm handoffs to managed care partners or community navigators **4. Complex Case Rounds (Weekly)** + Facilitate systemwide case rounds for… more
- Select Medical (Newport News, VA)
- …respiratory therapist or master's in social work and minimum three (3) years of medical case management or similar experience._** **Previous case mangement ( ... discharge planning ) experience with medically complex patients in a hospital critical care setting and...a related discipline. + Minimum three (3) years of medical case management or similar experience. +… more
- Stanford Health Care (Palo Alto, CA)
- …its inception. You can put your bedside RN experience to great use in case management working in conjunction with the medical teams, third-party companies, and ... and ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements. Case Managers act as consultants to the… more
- CVS Health (Springfield, IL)
- …5pm within time zone of residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Brockton Hospital (Brockton, MA)
- …of the Case Management Program for Signature Healthcare & Signature Medical Group The responsibilities include the development and supervision of staff (RNs, ... service delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to...Maps project. Acts as liaison with payors and external review agencies, to coordinate activities involved in medical… more
- Mount Sinai Health System (New York, NY)
- …Requirements** + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ... Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will...Supports the mission, vision, philosophy and goals of the Medical Center. + Case Management: The CM… more
- ChenMed (North Miami Beach, FL)
- …departments, and other healthcare facilities. + In conjunction with the PCP, Hospitalist, Medical Director, insurance case manager and the hospital case ... studies and special projects as assigned. + Conducts concurrent medical record review using specific indicators and...required. + A minimum of 1 year of utilization review and/or case management, home health, hospital… more
- Logan Health (Kalispell, MT)
- Join Our Case Mangement Team! . Our Mission: Quality, compassionate care for all. Our Vision: Reimagine health care through connection, service and innovation. Our ... | Work Together | Strive for Excellence. Logan Health Medical Center has an opportunity for an MSW or...you'll be doing: This position is part of our Case Management team and will play a vital role… more
- Sharp HealthCare (San Diego, CA)
- …federal regulatory requirements.The plan and interventions will be documented in the electronic medical record (EMR), and case management software.The RN CM I ... the system level, in clinics, with SCMG and other complex care Case Managers as appropriate, and...communicates this to the care team.Refer defined cases for medical secondary review and share findings with… more