- Las Palmas Medical Center (Socorro, TX)
- …and discharge planning for a specified patient population. Performs concurrent and retrospective review of patient medical records for purposes of utilization ... case management philosophy/process/role, needs assessment, principles of utilization review /quality assurance, use of InterQual(R) or other clinical decision… more
- HCA Florida Largo Hospital (Largo, FL)
- …and satisfaction.You will promote cost effectiveness through the integration of case management, utilization review management and discharge planning. What ... of our colleagues. The available plans and programs include:Comprehensive medical coverage that covers many common services at no...personal growth, we encourage you to apply for our Case Manager RN opening. We promptly review … more
- Houston Methodist Hospital (Houston, TX)
- …units.Initiates and facilitates referrals for home health care, hospice, and durable medical equipment. Consults with Social Worker Case Manager to assess ... At Houston Methodist, the Case Manager (CM) position is a registered nurse...for quality, patient satisfaction and safety measures.FINANCE ESSENTIAL FUNCTIONSPerforms review for medical necessity of admission, continued… more
- Ascension (Tulsa, OK)
- …medical necessity and/or compliance with reimbursement policy criteria. Provides case management and/or consultation for complex cases.Assist departmental ... Utilization ManagementSchedule: FT, Monday - Friday, 9am-5pmHospital: Ascension St. John Medical CenterLocation: Tulsa, OKBenefits Paid time off (PTO) Various health… more
- Ascension (Milwaukee, WI)
- …orthopedic, gynecologic and obstetric surgeries, along with patients that have complex medical diagnoses, respiratory failure, endocrine and metabolic ... Details Department: Medical Surgical ICUSchedule: 12 hour shifts; 7P-7A; RN's...our patients deserve. Daily multidisciplinary patient rounds support the review of patient care goals in a collaborative and… more
- Boston Children's Hospital (Waltham, MA)
- …Evaluation: Recognizes staff that are unreceptive to feedback and reports findings and trends. Case Cart Review : Reviews and inspects case carts for ... in other areas of the organization if needed.Principal Duties and ResponsibilitiesKit Review and Accuracy: Maintains review kits for accuracy and instrument… more
- Boston Children's Hospital (Boston, MA)
- …OR suite for surgery by verifying the availability of instrument kits before case start times.Meet daily with OR Specialty Coordinators at the Collaborative Daily ... Review to forecast instrument needs up to five days in advance.Monitor case flow throughout the day, track instrument needs, and notify SPD personnel of any… more
- HCA Florida Largo Hospital (Largo, FL)
- …career and retirement of our colleagues. The available plans and programs include:Comprehensive medical coverage that covers many common services at no cost or for a ... health coverage as well as free telemedicine services and free AirMed medical transportation.Additional options for dental and vision benefits, life and disability… more
- ECHN (Manchester, CT)
- …an ongoing basis through the performance of cultural and psychosocial assessment, including review of the medical record, as per department policy. Exemplary:# ... POSITION SUMMARY: The Medical Imaging (Radiology) RN Clinician will be responsible...admission and updates it throughout the hospitalization keeping the Case Manager or Nursing units well informed of patient… more
- HCA Florida Largo Hospital (Largo, FL)
- …career and retirement of our colleagues. The available plans and programs include:Comprehensive medical coverage that covers many common services at no cost or for a ... health coverage as well as free telemedicine services and free AirMed medical transportation.Additional options for dental and vision benefits, life and disability… more
- HCA Florida Largo Hospital (Largo, FL)
- …career and retirement of our colleagues. The available plans and programs include:Comprehensive medical coverage that covers many common services at no cost or for a ... health coverage as well as free telemedicine services and free AirMed medical transportation.Additional options for dental and vision benefits, life and disability… more
- Medical Mutual of Ohio (OH)
- … medical /pharmacy terminology/coding and managed care processes. Understanding of the medical review (ie, prior authorization) process and managed care ... years as a Registered Nurse with a combination of clinical and utilization/ case management experience in pharmacy, medical /surgical, or psychiatric, preferably… more
- Henry Ford Health System (Jackson, MI)
- …year (2) years of Epic Operating Room charge auditing. Knowledge of medical terminology This posting represents the major duties, responsibilities, and authorities ... of services - from primary and preventative care to complex and specialty care, health insurance, a full suite...Ford is one of the nation's most respected academic medical centers and is leading the Future of Health:… more
- Medical Mutual of Ohio (OH)
- …Supplement, and individual plans. Under limited supervision, the Medicare Nurse Reviewer applies medical necessity guidelines in making authorization ... health care services. + Participates with designated external vendors and Assistant Medical Directors, social workers and case managers to determine potential… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …optimize member care and ensure a constructive provider experience + Facilitate review process by communication with members/families, providers, medical staff ... healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have complex… 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
- Medical Mutual of Ohio (OH)
- …clinical utilization management background. Medicare experience is a plus. **Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance ... appropriate level of care. **Responsibilities** *Conducts pre-certification of basic to complex outpatient services, surgical and diagnostic procedures, and out of… more
- Stanford Health Care (Palo Alto, CA)
- …ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements. A health-system case management program has as ... + Utilization Management: Avoidable Delay Identification, Intervention & Tracking, Utilization Review , Medical Necessity Review , Care Plan Progression,… more
- University of Michigan (Ann Arbor, MI)
- Complex Case Manager Apply Now **Job Summary** Complex Care Managers provide comprehensive care management services to Michigan Medicine patients with ... complex medical and psychosocial needs. They possess...employer. **Job Detail** **Job Opening ID** 245091 **Working Title** Complex Case Manager **Job Title** Case… more
- Kepro (Oakland City, IN)
- …for health solutions in the public sector. Acentra is looking for an RN Complex Case Manager - Hybrid (Southwest Indiana Counties: Gibson, Pike, Warrick) 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
