- 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
- Point32Health (MA)
- …The Clinical Reviewer is responsible for making the determination of medical necessity and, therefore, benefit coverage for Commercial members. The Clinical ... benefit determinations using applicable coverage documents, purchased clinical guidelines or Medical Necessity Guidelines for clinically complex services /… 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 ... Acentra seeks an Internal Medicine or Family Practice 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
- Commonwealth of Pennsylvania (PA)
- …for supervising a team of clerical and technical staff who are involved in maintaining complex medical case histories. Your work will be overseen by an ... Medical Records Director - SCI Somerset Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4664207)...administrative supervisor, who will review your compliance with departmental and facility policies and… more
- The Cigna Group (Bloomfield, CT)
- …delegated tasks assigned by a supervisor in Utilization Management. Handles moderately complex medical review , utilization review , ... the following: + Laboratory molecular and genetic testing clinical case review activities. + Evaluate telephone, fax,...Strong interpersonal skills with the ability to clearly explain complex medical information in both verbal and… more
- Point32Health (MA)
- …of care. To facilitate coordination and integration of behavioral health, medical management, and case management services. KEY RESPONSIBILITIES: Conduct ... the treatment process. Identify through proactive concurrent reviews high-risk/high cost complex members for internal case management, and make appropriate… more
- Hildebrand Self-Help Center (Cambridge, MA)
- …Coordinate client care plans with hospital social workers for complex client medical issues. * Support Case Managers, ensuring clients are connected to ... an approach and internal system for dealing with client's complex medical issues. * Provide greater context... complex bureaucracies. * Focus on the most complex or unique cases where standard case … 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 (Logan, OH)
- …vital partner for health solutions in the public sector. Acentra seeks an RN Complex Case Manager in Logan, Ohio (covering Athens, Meigs, Gailia, Vinton, Jackson ... 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
- Kepro (Bloomington, IN)
- …a vital partner for health solutions in the public sector. Acentra seeks an RN Complex Case Manager in Greene, Sullivan, Knox, Clay, and Vigo counties 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
- 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. Facilitates patient and family education and the… more
- The City-County of Butte-Silver Bow (Butte, MT)
- HIV Health Educator- Ryan White Medical Case Manager Print (https://www.governmentjobs.com/careers/buttesilverbowmt/jobs/newprint/4674813) Apply HIV Health ... Educator- Ryan White Medical Case Manager Salary $19.00 Hourly Location...adherence counseling to ensure readiness for and adherence to complex HIV treatments. *Client-specific advocacy and/or review … 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
- Albany Medical Center (Albany, NY)
- …Inpatient Rehab - E8 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. + Facilitates patient and family education and… more
- HCA Healthcare (El Paso, TX)
- …to complete complex discharge plans. + You will Conducts concurrent medical record review using specific quality indicators and clinical decision support ... and discharge planning for a specified patient population. Performs concurrent and retrospective review of patient medical records for purposes of utilization … more
- Stanford Health Care (Palo Alto, CA)
- …Stanford Health Care **What you will do** + Coordination of Care -- - Complex case manager who manages each patient's transition through the system and ... use of resources, service delivery, and compliance with external review agencies' requirements. Case Managers act as...toward that end, to avoid duplication and misuse of medical services, control costs by reducing inefficient services, 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
- Select Medical (Lakeway, TX)
- …_302267_ **Location** _US-TX-Lakeway_ **Experience (Years)** _1_ **Category** _Clinical - Case Manager_ **_Street Address_** _2000 Medical Dr._ **_Company_** ... **Overview** **Baylor Scott & White Institute for Rehabilitation** **Lakeway, TX** ** Case Manager** **LMSW** **Outpatient Day Neuro Program** **PRN/ Per Diem**… more