- Marion County (Salem, OR)
- …provides services to individuals with serious and persistent mental illnesses and complex needs, many of whom also have co-occurring substance use disorders and ... medical conditions. You would have the opportunity to build...including intensive services, to individuals and their families with complex needs and diagnoses or to develop and implement… more
- Marion County (Salem, OR)
- …daily operations of the outpatient clinic, working closely with the medical team. The ideal candidate will be compassionate, detail-oriented, reliable, and ... and processes incoming requests for psychiatric medication interventions; provides case management.Prepares, organizes, and manages information/data/records pertinent to psychiatric… more
- City of New York (New York, NY)
- …lien re-payment. OLR/OLT is recruiting for (1) one Supervisor of Nurses to function as a Complex Medical Case Reviewer , who will: - Conduct medical ... to calculate injury related Medicaid liens pursuant to SSL-104b on cases involving Medical malpractice, mass medical torts, lead paint poisoning, traumatic brain… more
- Prime Healthcare (Newark, NJ)
- …readiness for, and adherence to complex HIV/AIDS treatments. Medical case management also includes client-specific advocacy and review of use of ... clinical team with resources, information, and performs the various steps of medical case management including completion of intakes, psychosocial assessments,… more
- Queen's Health System (Kamuela, HI)
- …Care Team to facilitate coordination of care across the continuum for selected complex patients. * Partners with Patient Care Team; maintains accountability for the ... as applicable. * Key responsibilities include, but are not limited to, case finding and assessment, patient/family education and advocacy, resource management and… more
- Intermountain Health (Murray, UT)
- …ongoing evaluation of the UM process. 4. Oversees the management physician reviewer services, including management of scheduling, optimizing review process, and ... **Job Description:** This position is responsible for providing physician peer review and clinical direction for SelectHealth including utilization management, … more
- Centers Plan for Healthy Living (Margate, FL)
- …plans they need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial Adverse ... RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063,...standards and policy and procedures. Investigation and preparation of case narratives and statements of position based on clinical… more
- Kepro (Lombard, IL)
- …clinical operations. + Represent the organization through state appeal processes. + Review medical information trends, experiences, and approaches and assist in ... in the public sector. Acentra seeks a Psychiatrist Physician Reviewer (Illinois Remote, PRN) to join our growing team....and clinical expertise to operations relating to the peer review process, utilization review activities, and other… more
- Lancaster General Health (Lancaster, PA)
- …of challenges and barriers to discharge including; mental health concerns, high cost medical care, complex medical needs, criminal history, housing ... is recruiting for a full-time inpatient Case Manager to join a team of dedicated Case Managers managing a variety complex cases. Case Managers on the … more
- Kepro (Summersville, WV)
- …being a vital partner for health solutions in the public sector. Acentra seeks an RN Complex Case Manager in West Virginia to join our growing team. Job Summary: ... The RN Complex Case Manager will: + Provide in-home,...continue the plan of care and support transition. + Review the care plan and progress in regular care… more
- CVS Health (Frankfort, KY)
- …to make health care more personal, convenient and affordable. Position Summary: The Complex Nurse Case Manager is responsible for assessing members through ... and coordinate all case management activities with members to evaluate the medical and psychosocial needs of the member to facilitate and support the member's… more
- The Cigna Group (Nashville, TN)
- …all aspects of the appeal have been addressed properly and accurately; e) prepare case files for submission to Independent Review Entity, which also include ... **Cigna Medicare Part C Appeals Reviewer : Appeals Processing Analyst** We will depend on...Medicare appeals and related issues, implications and decisions. The Case Management Analyst reports to the Supervisor/Manager of Appeals… more
- Crawford & Company (Houston, TX)
- … case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and ... Group Health, Liability and Disability. Responsibilities + May assist supervisor/manager in review of reports, staff development. + Reviews case records and… more
- Albany Medical Center (Albany, NY)
- …Care Management/Social Work Work Shift: Day (United States of America) The Case Manager is accountable to facilitate the interdisciplinary team to plan, coordinate, ... assigned service line across the continuum of care. The Case Manager works proactively with the Quality Improvement Teams,...in health care team care conference for patients with complex problems. g. Facilitates patient and family education and… more
- Albany Medical Center (Albany, NY)
- …America) Salary will commensurate with experience: Salary Range: $65,057-$107,343.00 The Case Manager is accountable to facilitate the interdisciplinary team to ... assigned service line across the continuum of care. The Case Manager works proactively with the Quality Improvement Teams,...in health care team care conference for patients with complex problems. + Facilitates patient and family education and… more
- Zufall Health Center (Somerville, NJ)
- Medical Case Manager Somerville, NJ 08876, USA...care from hospital to home, high utilization of services, complex medical needs or those at high risk ... to Zufall Health! Position Summary The goal of the Medical Case Manager (MCM) Nurse is to...in person and over the phone to remind and review their plan of care and progress towards their… more
- Sutter Health (Berkeley, CA)
- **Organization:** ABSMC-Alta Bates Herrick Campus **Position Overview:** The Psychiatric Case Manager coordinates the care of patients through the provision of ... clinical case management to assure that patients are being treated...planning, working knowledge of current reimbursement requirements (including Medicare, MediCal , private contracting), excellent communication skills, both written and… more
- Tenet Healthcare (Detroit, MI)
- …collaborating with physicians, office staff and ancillary departments, k) leading and facilitating Complex Case Review , l) assuring patient education is ... based on Medical Necessity process and submits case for Secondary Physician review per Tenet...risk assessment and referral to Social Work services and/or Complex Case Review . May delegate… more
- Stanford Health Care (Palo Alto, CA)
- …and ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements. Case Managers act as consultants to the ... cardiothoracic surgery, organ transplantation, neurology, neurosurgery, and cancer medicine. Case Managers supporting the Oncology Units work closely with patients,… more
- Sharp HealthCare (Coronado, CA)
- …care nursing experience or case management experience. + 3 Years case management, utilization review , care coordination experience. + California Registered ... plan and interventions will be documented in the electronic medical record (EMR) and other supporting case ...the system level, in clinics, with SCMG and other complex care Case Managers as appropriate, and… more
