- Elevance Health (Charleston, WV)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Veterans Affairs, Veterans Health Administration (Beckley, WV)
- …as it relates to nursing Staffing Methodology. Plans facility annual Staffing Methodology review Serves as an alternate Bed Management System (BMS) Coordinator. ... by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities Scope of Assigned Duties: The Staffing… more
- Elevance Health (Charleston, WV)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Veterans Affairs, Veterans Health Administration (Martinsburg, WV)
- …by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities The Mental Health (MH) Registered ... Nurse (RN) provides and leads the provision of competent,... independently provides patient- centered and recovery-oriented care, milieu management , and maintains self-awareness while caring for patients living… more
- Genesis Healthcare (Charleston, WV)
- …written, verbal and listening communication abilities.9. Prior experience in utilization review or discharge planning preferred.10. Certifications: CCM, ... job grade, location, and length of service. The Care Transitions Nurse develops strong relationships with Hospital/Health System providers, Hospitalists, Physicians,… more
- Fresenius Medical Center (Dunbar, WV)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Princeton, WV)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Marriott (Charleston, WV)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... claims most likely to benefit from case management to meet jurisdictional needs. ** Utilization Review ** + Provide initial clinical review in order to… more
- CVS Health (Charleston, WV)
- …health care more personal, convenient and affordable. Position Summary The Care Management Associate (CMA) role is a full time remote telework position. Qualified ... welfare population health members, and carries a caseload. The Care Management Associate supports comprehensive coordination of medical services including Care Team… more
- Amergis (Point Pleasant, WV)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... regarding accessibility of services + Follows State/County mandated guidelines for the nurse case management programs + Participates in outreach activities to… more
- CVS Health (Charleston, WV)
- …experience + Foster care experience + Crisis intervention skills + Managed care/ utilization review experience + Certified Case Manager (CCM) certification + ... and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member… more
- CommuniCare Health Services Corporate (Keyser, WV)
- … + Weekly visits to facilities for intervention, audit and training + Review resident clinical records for coverage, utilization , errors, assessments and ... RN Mobile MDS Coordinator, Registered Nurse CommuniCare Health Services is currently looking to...experience with Federal Medicare/Medicaid and Managed Care reimbursement system management in working with the MDS and RAI process… more
- CVS Health (Charleston, WV)
- …experience + Foster care experience + Crisis intervention skills + Managed care/ utilization review experience + Certified Cas Manager (CCM) certification + ... of the state. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, Aetna Better Health… more