- CVS Health (Phoenix, AZ)
- …caseworkers assigned to you for support. You will perform an end-to-end quality review of written grievances resolution letters and summaries that are drafted by the ... quality objectives are met. Based on the outcome of case reviews, you will identify quality or productivity issues...needed. This may include working grievance cases, final quality review , and supporting grievance triage and assignment. To be… 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)
- …health care services. + Participates with designated external vendors and Assistant Medical Directors, social workers and case managers to determine potential ... Under limited supervision, applies medical necessity guidelines in making authorization determinations for inpatient admissions, concurrent, and retrospective… more
- Medical Mutual of Ohio (OH)
- …the flexibility to work at home within the state of Ohio. **Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in ... appropriate level of care. **Responsibilities** *Conducts pre-certification of basic to complex outpatient services, surgical and diagnostic procedures, and out of… more
- US Tech Solutions (CA)
- …Years + Responsibilities include ** medical review ,** which involves in-house review of ** Case Report Forms (CRFs) i** ncluding query resolution and ... in Microsoft Office tools, Data Analysis, Research, Data Automation, Case processing of Device SAE/AEs, device complaints and SADE... and Client community by responding to inquiries with medical /scientific information that is more complex and… more
- Kepro (Brazil, IN)
- …vital partner for health solutions in the public sector. Acentra seeks an RN Complex Case Manager in Brazil, Indiana (Counties: Greene, Sullivan, Knox, Clay, and ... Vigo) 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
- CVS Health (Jeffersontown, KY)
- …to make health care more personal, convenient and affordable. **Position Summary:** The Complex Nurse Case Manager is responsible for assessing members through ... and coordinate all case management activities with members to evaluate the medical and psychosocial needs of the member to facilitate and support the member's… more
- Covenant Health (Nashua, NH)
- …+ Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all mandatory learning assignments ... Summary Conducts medical necessity reviews in accordance with the Utilization...team. + Annual goals are achieved. + Attends pertinent case management/utilization review programs to maintain current… more
- Select Medical (Gainesville, FL)
- …respiratory therapist or master's in social work and minimum three (3) years of medical case management or similar experience._** **Previous case mangement ( ... discharge planning ) experience with medically complex patients in a hospital critical care setting and...a related discipline. + Minimum three (3) years of medical case management or similar experience. +… 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
- Travelers Insurance Company (Hartford, CT)
- … medical , and expense management, investigations, subrogation, structured settlements, medical case and litigation management. + Oversee the development ... industry leading best practices for the most serious and complex workers' compensation claims. Drives performance of a Workers...and regulations. + Extensive claim and/or legal experience and/or medical case management experience and thus the… more
- Stanford Health Care (Palo Alto, CA)
- …(Palo Alto, CA; onsite) **What you will do** + Coordination of Care -- - Complex case manager who manages each patient's transition through the system and ... and ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements. Case Managers act as consultants to the… 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
- Brockton Hospital (Brockton, MA)
- …of the Case Management Program for Signature Healthcare & Signature Medical Group The responsibilities include the development and supervision of staff (RNs, ... service delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to...Maps project. Acts as liaison with payors and external review agencies, to coordinate activities involved in medical… more
- Mount Sinai Health System (New York, NY)
- …Requirements** + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ... Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will...Supports the mission, vision, philosophy and goals of the Medical Center. + Promotes an environment that is sensitive… more
- Carnival Cruise Line (Miami, FL)
- …required or requested in terms of complex cases. + Assist with and review of medical charts when required or requested for medicolegal purposes and ... timeliness of communication and support from the company and review return to work. The Case Management...team and shore-side medical providers to facilitate medical appointments, assist with retrieval and review … more
- Mount Sinai Health System (New York, NY)
- …on units as warranted. 2. Meets with Case Managers, as warranted, to review medically complex and long stay cases; refer to physician advisor as indicated. ... 10. Attends interdisciplinary rounds as necessary. 11. Meets with Case Managers to review medically complex...Sinai Health System is one of the largest academic medical systems in the New York metro area, with… more