Description: - Responsible for meeting all State and Federal regulations as well as the clients mandates related to claims and preauthorization processing - Responsible for accurate and timely medical review of claims and preauthorizati...
initiatives. Qualifications: Registered Nurse required BSN required MSN preferred Director of Case Management experience in... collaboratively with leaders of Utilization Management to quickly and efficiently address any Case Management or Utilization...
plan prior to discharge Communicate and collaborate with Utilization Management regarding patient status, changes in plan...Job Description: Under the general direction of the Director and Lead/Supervisor Case Management RN, the Case...
Liaison you will be an expert in resource management, a master of utilization review and a compassionate partner for patients... with a geriatric population). You are an expert in Utilization Management and have knowledge of URAC & NCQA standards...
The nurse manager co-creates a culture of excellence, innovation, and transformation with professional nurses..., other leaders, and Associates. The nurse manager fosters healthy work environments, advances professional autonomy, clinical...
. Must have a valid Florida state license as a Licensed Practical Nurse (LPN). PERFORMANCE APTITUDES Data Utilization: Requires the... one position in the class. The omission of an essential function does not preclude management from assigning duties not listed...
. Must have a valid Florida state license as a Licensed Practical Nurse (LPN). PERFORMANCE APTITUDES Data Utilization: Requires the... one position in the class. The omission of an essential function does not preclude management from assigning duties not listed...
Job Description: The nurse manager co-creates a culture of excellence, innovation, and transformation... with professional nurses, other leaders, and Associates. The nurse manager fosters healthy work environments, advances professional...
patients’ risk factors and the need for care coordination, clinical utilization management, and preventive care services... working relationship with the Patient and Family Counselors/Social Workers and the Utilization Review Nurses to engage the...
patients’ risk factors and the need for care coordination, clinical utilization management, and preventive care services... working relationship with the Patient and Family Counselors/Social Workers and the Utilization Review Nurses to engage the...
’s license, auto insurance and reliable transportation. Two years as a Registered Nurse with at least one-year of management... based on own the review of clinical documentation in addition to feedback and recommendations by Utilization Review staff...
resources monitoring, and clinical care escalations. The RN Case Manager is under the general supervision of the Care Management..., patient satisfaction, patient safety, readmission prevention and length of stay management. The RN Case Manager communicates...
utilization of surgeon block time and operating room suite use as directed. Maintains current list of surgeons, monitors... and sterilization of instruments and accessories as directed. Communicates with Materials Management and SPD staff to ensure routine...
utilization of surgeon block time and operating room suite use as directed. Maintains current list of surgeons, monitors... and sterilization of instruments and accessories as directed. Communicates with Materials Management and SPD staff to ensure routine...
per week Shift: Monday - Thursday, 8am - 6pm | Fridays are off Title: Registered Nurse, Care Coordinator - General... coordination services to include assessing patients’ risk factors and the need for care coordination, clinical utilization...
factors and the need for care coordination, clinical utilization management, and preventive care services. Responsibilities...: Monday - Friday, 8am - 5pm Title: Registered Nurse, Care Coordinator - General Neurology ***Address of Practice: 10000...
, providing health education, specialty referrals and case management referrals, providing follow-up care and applying clear, in..., population management of market's members, and oversight of PCP's cardiovascular skills. Leads a cardiovascular care team...
Must have Two (2) years of experience as a registered nurse in a surgical area or surgical tech required. One (1) year experience in... with operating room policies and procedures. Monitors utilization of surgeon block time and operating room suite use as directed...
Shift: Day Must have Two (2) years of experience as a registered nurse in a surgical area or surgical tech... compliance with operating room policies and procedures. Monitors utilization of surgeon block time and operating room suite...
for their pre-admission optimization clinics and the Nurse Practitioner services. As a Medical Director, Physician will have varied... documentation review of each Physician/Nurse Practitioner per Medical Staff guidelines. Provide professional services through...