- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** To provide comprehensive utilization management and coordination of care for members who ... with contracted health plan requirements for documentation of concurrent SNF review and utilization management ...of care Works collaboratively with the Hospitalist Care Team and Care Management … more
- UNC Health Care (Apex, NC)
- …in the skilled nursing facility. Acts as liaison between staff, physicians, and management . Also performs direct patient care . Responsibilities: 1. Ensures ... and employee performance reviews. Acts as liaison between staff, physicians, and management . 4. Participates in direct patient care ; maintains current skills… more
- Humana (Pierre, SD)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- UCLA Health (Los Angeles, CA)
- …the Case Management Coordinator is responsible for patient high risk care coordination activities in hospital, SNF and outpatient settings during afterhours ... with: * High school diploma, GED, or equivalent * Experience working in case management and care coordination in managed care environment preferred *… more
- Sharp HealthCare (San Diego, CA)
- …Home Health and/or SNF setting. + 2 Years Utilization /Case Management experience, preferably in a Managed Care setting. + California Licensed Vocational ... and employer business practices. **What You Will Do** To provide comprehensive utilization management and coordination of care for SRS Members. Ensure timely… more
- Sharp HealthCare (San Diego, CA)
- …Skills, and Abilities** + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, ... admits, repeat same type services for need for further management of health care .When a patient is...routine, urgent and expedited referrals as outlined in SCMG's Utilization Management Plan.Decisions will be communicated to… more
- Sharp HealthCare (San Diego, CA)
- …Skills, and Abilities** + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, ... document management system.Reviews for medical necessity and appropriateness of services/ care based on health plan members medical condition, with the … more
- Actalent (Houston, TX)
- …+ MINIMUM 2 years clinical experience in a clinical setting + Experienced in Utilization Management and knowledge of URAC & NCQA standards + Broad knowledge ... to hire multiple RNs to join a growing managed care organization on a Sunday to Thursday OR Tuesday...Sunday to Thursday OR Tuesday to Saturday basis doing utilization review for PAC patients. This role is looking… more
- Intermountain Health (Provo, UT)
- …social work staff. Work with SNF staff in developing patient-specific post- SNF care plan, reconciling medications at discharge, and communicating with clinic ... based care manger to assure smooth post- SNF transition.... management /SW routinely regarding acute and chronic illness management Attends family meetings Informs patients' primary care… more
- St. Peters Health (Helena, MT)
- …. Essential Position Functions + Provide targeted, proactive, relationship-based (longitudinal) care management to all patients identified as at increased ... and their families, to foster quality, continuity and appropriate utilization of health care resources throughout the...process and who are likely to benefit from intensive care management . + Provide short-term (episodic) … more
- ChenMed (Wichita, KS)
- …identify and correct knowledge deficits. + Hospital bedside discussion explaining our Care Management /Disease Management program with verbal introduction to ... when patient discharges to a Skilled Nursing Facility ( SNF ) or Long-Term Care (LTC) to provide...experience required. + A minimum of 1 year of utilization review and/or case management , home health,… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! RN Care Manager - Inpatient CARE ... Care Manager provides services consisting of comprehensive care management , care coordination and...Maintains respectful and professional communication skills. * Insurance and Utilization Management * Maintains working knowledge of… more
- Guthrie (PA)
- …who demonstrates leadership and autonomy in nursing practice. Preferred experience with care management / utilization review, and payer knowledge. Fast paced ... for treatment regimen adherence and medication management to support self- management and independent living. 7. Identifies potential care gaps and… more
- UNC Health Care (Morrisville, NC)
- …workflows for scheduling (including travel for community based), clinical documentation, care management , phone triage, and other operational needs-Develops ... and families, direction of quality improvement efforts and patient/family experience, management of palliative care staff, timeliness and effectiveness of… more
- St. Peters Health (Helena, MT)
- …. Essential Position Functions + Provide targeted, proactive, relationship-based (longitudinal) care management to all patients identified as at increased ... and their families, to foster quality, continuity and appropriate utilization of health care resources throughout the...process and who are likely to benefit from intensive care management . + Provide short-term (episodic) … more
- Bozeman Health (Bozeman, MT)
- …experience in hospital social work or protective services + Working knowledge/experience in utilization management , managed care , and payor issues Essential ... Pediatric Social Worker Position Summary: The Case Management Social Worker I intervenes with patients who...area. Informs Department regarding trends and issues related to SNF and Rehab facility quality of care .… more
- ChenMed (Louisville, KY)
- …physical exam, diagnosis and treatment, development of the nursing plan of care , health education, physician referrals, case management referrals, follow-up and ... independently upon the completion of documented competency. + Participates in patient care rounds and conferences. Communicates patient management strategies to… more
- Emory Healthcare/Emory University (Duluth, GA)
- …review of medical necessity for all inpatients, concurrent stay documentation per utilization management plan, verification and correction of patient status, ... to plan across the continuum; Provides ongoing educational opportunities to enhance health care teams knowledge of case management services; Participates in and… more
- Emory Healthcare/Emory University (Duluth, GA)
- …review of medical necessity for all inpatients, concurrent stay documentation per utilization management plan, verification and correction of patient status, ... to plan across the continuum; Provides ongoing educational opportunities to enhance health care teams knowledge of case management services; Participates in and… more
- ChenMed (Pembroke Pines, FL)
- …with the nurse case managers to transition patients to the appropriate level of care post hospital/ SNF discharge and may perform post discharge follow up in ... of records and activity reports. ESSENTIAL JOB DUTIES/RESPONSIBILITIES: + Assists with the management and plan for transitions of care , discharge and post… more