resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager... of clinical information to support and determine medical necessity criteria and contract benefits. •20% Utilizes allocated...
resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager... of clinical information to support and determine medical necessity criteria and contract benefits. 20% Utilizes allocated...
to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals..., cost effective outcomes. 60% Provides active case management, assesses service needs, develops and coordinates action...
Clinical DRG and Coding disparities in dispute from the insurer/auditor. Follow workflow processes to comply with contract... based committees as approved by Manager. Partners with CDI and Coding Analysts to advance practices focused on clinical...
Life Skills Specialist, Case Manager, and Clinical Specialist on scheduling and assigned duties and prioritize to problem... staff and the Clinical Specialist, Nurse Practitioner, RN, and treatment team. The Clinical Lead will also assist with the...
1 Weekend Shift Per Contract Requirements: WA is part of the PT compact privilege states 1 year Skilled Home Health... experience Skills: Start of Care, Admissions, Case Management, Recertification, Urinary Catheter Insertion / Management, Wound...
for working under the direction/supervision of an RN, with overall responsibility for the member's case. As required by applicable... state law and contract, the Clinician contributes to the LTSS care coordination process by performing activities within the...
Management Nurse (LPN or RN) uses a multidisciplinary approach to organize, coordinate, monitor, evaluate, create and manage... criteria/guidelines to determine medical necessity, benefit eligibility, and network contract status. Work with Medical...
improvements in collaboration with plant management. Job Qualifications Education: Bachelor's degree in nursing, active RN... setting. Certification/Licensure: CPR certified. Experience in case/care management, disability, and worker's compensation...
. Your Responsibilities Provides technical, clinical and programming assistance, primarily in support of 1-2 Territory Manager(s). Assist... and establishes strong rapport with customers. Proficient in complex programming, case support. Works seamlessly with Territory...
. Your Responsibilities Provides technical, clinical and programming assistance, primarily in support of 1-2 Territory Manager(s). Assist... and establishes strong rapport with customers. Proficient in complex programming, case support. Works seamlessly with Territory...
accommodation in order to fulfill any or all of these essential functions, I will notify my manager immediately (or in the case... in case setups with essential equipment and supplies as directed by circulating nurse. Assists in preparation of room set up...
must have an unrestricted NY RN license and a minimum of two (2) years in-home experience. Get ready for an exhilarating package of perks... to determine and summarize facts and assess any issues identified. - Perform other special projects not related to a specific case...
any issues identified. - Perform other special projects not related to a specific case such as general legal research, general... to the case. -Document any concerns, conflicting information, other issues that surface during the evaluation process...
. Your Responsibilities Provides technical, clinical and programming assistance, primarily in support of 1-2 Territory Manager(s). Assist... and establishes strong rapport with customers. Proficient in complex programming, case support. Works seamlessly with Territory...
. Your Responsibilities Provides technical, clinical and programming assistance, primarily in support of 1-2 Territory Manager(s). Assist... and establishes strong rapport with customers. Proficient in complex programming, case support. Works seamlessly with Territory...
and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract; develops... Coordinator Level 1 is responsible for overall management of member's case within the scope of licensure; provides supervision...
and South Carolina Home Care regulations. This oversight will include care management as required by regulation or contract..., coordinates, evaluates, and develops client care teams to ensure quality care delivery and appropriate case management within the...
and South Carolina Home Care regulations. This oversight will include care management as required by regulation or contract..., coordinates, evaluates, and develops client care teams to ensure quality care delivery and appropriate case management within the...
and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract; develops... Coordinator Level 1 is responsible for overall management of member's case within the scope of licensure; provides supervision...
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