- UNC Health (Chapel Hill, NC)
- …continuity of care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager ... Maintain knowledge of patient needs and concerns through scheduled touch points and review of documentation . Escalate urgent or complex cases to appropriate… more
- 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
- General Dynamics Information Technology (Fairfax, VA)
- …today is safe and tomorrow is smarter. Our work depends on a motivated BI Case Reviewer - casual joining our Personnel Vetting and Security team to support ... located in Chantilly, VA. At GDIT, people are our differentiator. As a BI Case Reviewer - casual you will support a large national background investigations… more
- Independent Health (Buffalo, NY)
- …benefits and commitment to diversity and inclusion. **Overview** The Contractual Reviewer -Senior will be responsible for providing an organized, timely and ... consistent review and investigation of provider and/or member complaints and/or...of provider and/or member complaints and/or appeals. The Contractual Reviewer -Senior will be required to rely on their ability… more
- University of Miami (Hialeah, FL)
- …. The Clinical Documentation Integrity (CDI) Second Level Reviewer performs high-level, complex , secondary case ... for measuring and reporting physician and hospital outcomes. + Performs high-level, complex , timely secondary case reviews concurrently and retrospectively to… 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 ... in the public sector. Acentra seeks a Psychiatrist 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
- Veterans Affairs, Veterans Health Administration (Martinsburg, WV)
- …Martinsburg VAMC is recruiting for one full-time Registered Nurse, Risk Manager-Clinical Reviewer . The nurse brings principles and theory with limited application of ... (TJC). Performs clinical reviews for Occurrence Screens and discusses possible Peer Review opportunities when quality of care issues are recognized. Assists with the… more
- Bright Horizons (Newton, MA)
- …sponsored benefit. One important aspect of this benefit is the expert review of college application essays. Our **Essay Reviewers** provide detailed evaluation and ... experienced college admissions officer or college counselor our Essay Reviewer position may be for you! **What you will...Working autonomously on tasks, but deferring to management for complex situations **What we hope you will bring to… more
- Lancaster General Health (Lancaster, PA)
- …of challenges and barriers to discharge including; mental health concerns, high cost medical care, complex medical needs, criminal history, housing ... is recruiting for a full-time inpatient Case Manager to join a team of dedicated Case Managers managing a variety complex cases. Case Managers on the … more
- Kepro (New Martinsville, WV)
- …being a vital partner for health solutions in the public sector. Acentra seeks an RN Complex Case Manager in West Virginia da 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
- CVS Health (Louisville, 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
- Sharp HealthCare (Chula Vista, CA)
- …office, revenue cycle, payors, long term care, sub-acute facilities, and patients/families. Reviews complex request for medical care and services, if part of the ... nursing facility admission, including requests for outpatient care, retrospective claim review , durable medical equipment, medication issues and acquisition,… more
- Crawford & Company (Houston, TX)
- … case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and ... Group Health, Liability and Disability. Responsibilities + May assist supervisor/manager in review of reports, staff development. + Reviews case records and… more
- Sedgwick Government Solutions (Orlando, FL)
- Job Details Medical Case Manager (Remote) 2024-1348 Orlando, FL, USA Medical Services Full Time Description Nurse Case Manager (Home Based) - Specialty ... various stages of recovery while tracking in a proprietary case management system. You will implement integrated medical...the critical communication link between the parties involved in complex medical disability cases. You will ensure… 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. g. Facilitates patient and family education and… more
- Avera Marshall (Sioux Falls, SD)
- … Manager is a specialized nurse that identifies members who would benefit from complex /chronic condition case management and/or service coordination. + The RN ... with physicians, population health staff, employers, community organizations, hospital-based case managers/utilization review staff, clinic-based care coordinators/preauthorization… 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
- Sutter Health (Berkeley, CA)
- **Organization:** ABSMC-Alta Bates Herrick Campus **Position Overview:** The Psychiatric Case Manager coordinates the care of patients through the provision of ... clinical case management to assure that patients are being treated...planning, working knowledge of current reimbursement requirements (including Medicare, MediCal , private contracting), excellent communication skills, both written and… more
