- Luminis Health (Lanham, MD)
- …Duties: 1. Chart Review : Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization ; ... Position Objective: Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization... : Monitors and identifies patterns or trends in utilization management ; monitors potential and actual denials… more
- Integrated Resources Inc. (Miami, FL)
- …manager is looking for 3 years of Inpatient Medical experience, 3 years of Utilization experience, Concurrent Review experience and HMO exp. A strong candidate ... directly tied to our clients' success. Job Description Under general supervision by management , and in collaboration with Medical Directors and other members of the… more
- The Laurels of Salisbury (Salisbury, NC)
- …hard-working team that values communication and strong teamwork abilities. Responsibilities: The Care Management Nurse , MDS Nurse works the RAI process and ... Are you an experienced nurse who wants to remain clinically involved in...PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management… more
- Geisinger (Wilkes-Barre, PA)
- Job Title: RN - Graduate Registered Nurse (Geisinger Wyoming Valley, Wilkes-Barre) To be considered for an interview, please make sure your application is full in ... found below. Location: Wilkes-Barre, Pennsylvania Job Category: Inpatient RN - Registered Nurse , Nursing and Nursing Support Schedule: Rotation Work Type: Full time… more
- Geisinger (Scranton, PA)
- Job Title: RN - Graduate Registered Nurse (Geisinger Community Medical Center, Scranton) A variety of soft skills and experience may be required for the following ... below carefully. Location: Scranton, Pennsylvania Job Category: Inpatient RN - Registered Nurse , Nursing and Nursing Support Schedule: Rotation Work Type: Full time… more
- Arthur J. Gallagher & Co. (AJG) (Torrance, CA)
- …marketplace; manage bill review and the nurse case managers including utilization review and case management functions. Ensure compliance of MPN with ... Care units. Review and report on monthly financials for case management and bill review . Management liaison with Enlyte / Genex, Harbor Health, One Call.… more
- Danbury Hospital (Danbury, CT)
- …CMS, Joint Commission, and other regulatory bodies related to discharge planning, utilization review , and care transitions. Monitor and analyze key performance ... heart failure treatment Healthgrades - One of America's 50 Best Hospitals Surgical Review Corporation (SRC) - Robotic Center of Excellence Joint Commission - Gold… more
- AlohaCare (Honolulu, HI)
- …offices on Quality Improvement and HEDIS/STARS metrics initiatives. Oversees Utilization Management toward an effective concurrent review process and case ... to contracts promoting clinical services and quality outcomes. Oversees Utilization Management toward an effective concurrent review process and case … more
- Kaiser Permanente (Vallejo, CA)
- …the standards for corrective action plan for improvement identified through utilization review , clinical records audit, claim denials, member satisfaction ... quality improvement evaluations, special projects, and other work for multidisciplinary review ; defining the standards for integrating multiple utilization data… more
- University of New Mexico - Hospitals (Albuquerque, NM)
- …patient responses to interventions in collaboration with quality assurance and utilization review , maintaining interdependent follow-up as necessary * VARIANCE ... case management interventions by utilizing established procedures including census review , risk screens, and referral * DATA - Perform assessment, data… more
- Kaiser Permanente (Pleasanton, CA)
- …by: researching corrective action plan for areas of improvement identified through utilization review , clinical records audit, claim denials, member satisfaction ... stakeholders to develop resolutions. Develops stakeholder development and quality performance review processes by: developing and improving the utilization and… more
- University of New Mexico - Hospitals (Albuquerque, NM)
- …to experience, education, and other business and organizational considerations. Department: Utilization Management - UH Considering making an application for ... patient responses to interventions in collaboration with quality assurance and utilization review , maintaining interdependent follow-up as necessary * VARIANCE… more
- The Laurels of Huber Heights (Dayton, OH)
- …expected candidate experience, and accompanying qualifications. The MDS Coordinator supervises the Care Management Nurse , MDS Nurse . The Laurels of Huber ... Are you an experienced Registered MDS nurse interested in the next step? The RN...PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management… more
- The Laurels of Huber Heights (Dayton, OH)
- …assessments and care plan coordination for guests. The MDS Coordinator supervises the Care Management Nurse , MDS Nurse . Be one of the first applicants, ... Are you an experienced Registered MDS nurse interested in the next step? The RN...PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management… more
- The Laurels of Fulton (Perrinton, MI)
- …assessments and care plan coordination for guests. The MDS Coordinator supervises the Care Management Nurse , MDS Nurse . The Laurels of Fulton offers one ... Are you an experienced MDS nurse interested in the next step? The MDS...PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management… more
- LightHouse Behavioral Health Center, LLC. (Baltimore, MD)
- …Approve treatment plans, assessments, and discharge planning activities Monitor utilization review and case assignments Ensure trauma-informed, culturally ... during rounds, site visits, and staff monitoring Prolonged desk work for documentation review and EHR navigation Occasional lifting of materials or supplies (up to… more
- Baptist Memorial Health (Southaven, MS)
- …and/or life situation. Performs other duties as assigned. Responsibilities Utilization Review Discharge planning Readmission Reduction Participation Payer ... of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal...Manager Facility: BMH - Desoto Hospital Department: DC Case Management Admin BMH Desoto Category: Nurse RN… more
- Luminis Health (Lanham, MD)
- …to the unit at education/staff development functions as well as designated management functions to promote high quality, cost effective health care. This position ... to hiring, evaluating performance, issuing final disciplinary actions under the review of Human Resources, and recommending discharge in collaboration with members… more
- NHS Management (Athens, AL)
- …care standards through oversight of quality assurance, infection control, and utilization review activities Receive and communicate physician instructions ... families Qualifications for the LPN Weekend Supervisor: Current and active Licensed Practical Nurse (LPN) license in the state of employment Minimum of two (2) years… more
- NHS Management (Madison, AL)
- …maintaining resident care standards related to quality assurance, infection control, and utilization review Receive and communicate physician orders and ensure ... liaison between residents, families, and staff Qualifications: Current and active Registered Nurse (RN) license in the state of employment Minimum of two (2)… more
