campaign-Case-Mgmt/MDS company_name-Palomar-Health-Rehabilitation-Institute industry-10460 is_manager-Palomar-Health.../requestsofcompletedclinicalreviews,includingapprovals,appeals,anddenials,andcommunicatesthesetotheappropriatepersonnel[hospitalstaff,physician,DCM...
Job Description: Schedule is Mon-Fri 10am-7pm The Behavioral Health Registered Nurse Case Manager will report... to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate...
clinical judgment and independent analysis, collaborating with members and those involved with members care including clinical... nurses and treating MDs.. The Case Management Nurse, Senior will report to the Manager, Care Management. In this role...
information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management... in the technical aspects of the retrospective review process for authorizations and Member or Provider Appeals, including...
related to follow-up, denials, and appeals. Essential Duties and Responsibilities Examines denied and underpaid claims... on each payer, including contact names, addresses, phone numbers, and other pertinent information. Notifies PFS Manager of changes...
clinical judgment and independent analysis, collaborating with members and those involved with members care including clinical... nurses and treating MDs.. The Case Management Nurse, Senior will report to the Manager, Care Management. In this role...
responses/requests of completed clinical reviews, including approvals, appeals, and denials, and communicates these to the... appropriate personnel [hospital staff, physician, DCM, Case Manager, Clinical Denial Management, and Centralized Business Office...
Qualifications 1 Year experience in the acute patient care, SNF, home health, or hospice settings. Experience as a case manager... admission review of the case manager and reviews with the Case Manager Lead, as needed. Keeps SRS Leadership informed...
national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer... Prior Authorization (PA) Technician plays a key role in assisting the clinical review pharmacist with daily tasks...
, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report... to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures...
and clinical best practice to concurrently screen admission review and review with payors in collaboration with Case Management..., and all staff members. Will do UR and enter data in EPIC. Reports to MANAGER, CASE MANAGEMENT Supervises N/A Ages...
Job Description: Your Role The Case Management team performs case management (CM) activities demonstrating clinical... judgment and independent analysis, collaborating with members and those involved with members care including clinical nurses...
, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior LVN, Care Manager... will report to the Manager of Care Management. In this role you will work in the Outreach and Engagement department, and play...
, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report... to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures...
authorization of designated healthcare services, continuity or care, and access to care clinical review determinations. The... Utilization Management Nurse, Senior will report to the Manager, Utilization and Medical Review. In this role...
, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report... to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures...
and appeals. This role entails overseeing a team of utilization review nurses and coordinators, ensuring compliance with clinical..., and efficiency of outpatient/ambulatory services per health plan and regulatory standards. Assists the Manager of Medical Management...
and appeals. This role entails overseeing a team of utilization review nurses and coordinators, ensuring compliance with clinical..., and efficiency of outpatient/ambulatory services per health plan and regulatory standards. Assists the Manager of Medical Management...
; approvals, appeals and denials and communicates these to the appropriate people (hospital staff, physicians, DCM, Case Manager... with the peer-to-peer coordination, and denials / appeals tracking. This position serves as a liaison between the Case...
, revise, and enhance clinical appropriateness guidelines. Perform first level provider appeals of coverage decisions... imaging, cardiac testing and sleep management services. Medical Directors in Clinical Operations determine the medical...