Outside Sales Representative Integrated Power ServicesOutside Sales RepresentativeLewisville, TXFull timeResponsibilities & Expectations: IPS is seeking an Outside Sales Representative focused on driving growth within our power distribution equipment and field services market by building strong relationships with end users in the DFW area. Qualifications and Competencies: Associate’s degree from an accredited 2-year technical college preferred (electrical power focus), or equivalent military training (Army Prime Power, Air Force Electrical Power Production, or Navy Seabee preferred).
RN Care Manager - Emergency Department (ED) - 26-00630 NavitasPartnersRN Care Manager - Emergency Department (ED) - 26-00630New York, NY$52–$60 / hourThis role partners closely with physicians, nursing staff, and interdisciplinary teams to ensure safe, timely, and effective patient transitions across care settings while maintaining regulatory compliance and high-quality patient-centered care. About Navitas Healthcare, LLC certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals.
Grievance Nurse Kinetic Personnel Group, Inc.Grievance NurseOrange, CA$43–$65 / hourUtilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment. A permanent position does include excellent CalPERS pension, 401a (4% contribution) and excellent government benefits and Holiday/PTO schedule.
NewAssistant Director of Nursing, RN Linden Ponds by Erickson Senior LivingAssistant Director of Nursing, RNWeymouth, MA$120,000–$150,000 / yearLocation: Linden Ponds by Erickson Senior Living Join our team as the Assistant Director of Nursing is responsible for clinical leadership and outcomes within our Skilled, Assisted Living, and Memory Care neighborhoods. See Erickson Senior Living Privacy Policy at https://www.ericksonseniorliving.com/privacy-policy and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.
Inpatient Care Navigator/Discharge Planner RN Or SW, Per Diem Day Shift, Care Navigation Adventist HealthCareInpatient Care Navigator/Discharge Planner RN Or SW, Per Diem Day Shift, Care NavigationSilver Spring, MDNicotine products" include, but are not limited to: cigarettes, cigars, pipes, chewing tobacco, e-cigarettes, vaping products, hookah, and nicotine replacement products (e.g., nicotine gum, nicotine patches, nicotine lozenges, etc.). Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing.
Infusion RN - Medical Oncology Pacific Cancer CareInfusion RN - Medical OncologyLos Gatos, CA$65–$91 / hourAs a core member of our interdisciplinary oncology team, the Infusion RN will play a critical role in delivering safe, evidence‑based chemotherapy, immunotherapy, and supportive treatments in a patient‑centered environment. The Infusion RN will partner closely with physicians, APPs, and fellow nurses to support patients and families through complex treatment decisions, active cancer therapy, and the broader continuum of care.
NewRN Case Manager Interim HealthCareRN Case ManagerCadiz, OHFull timeTo qualify as a Registered Nurse Case Manager (RNCM) with us, you will need: Licensure: Current unrestricted license to practice as a Registered Nurse (RN) in the state associated with this position. We take a patient-centric approach to address each individual's mind, body, and spirit, our caregivers work tirelessly to help their patients and families find peace.
RN Case Manager- Sign-on Bonus - $7,500 Interim HealthCareRN Case Manager- Sign-on Bonus - $7,500Martinsville, INFull timeWe take a patient-centric approach to address each individual's mind, body, and spirit, our caregivers work tirelessly to help their patients and families find peace. •One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred.
RN Case Manager- *Home Visits Interim HealthCareRN Case Manager- *Home VisitsWilliamstown, KYTo qualify as a Registered Nurse Case Manager (RNCM) with us, you will need: · Licensure: Current unrestricted license to practice as a Registered Nurse (RN) in the state associated with this position. We take a patient-centric approach to address each individual’s mind, body, and spirit, our caregivers work tirelessly to help their patients and families find peace.
NewRN - MICU Yale New Haven HealthRN - MICUNorth Stamford, CTDevelops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And Supervises Individual Patient Care On A Nursing Unit/Department According To Unit Policies And Procedures.
Nurse Reviewer 1 Elevance HealthNurse Reviewer 1Grand Prairie, TexasRequires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization requests to assess the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment.
Case Manager-Registered Nurse (RN)-PRN Houston MethodistCase Manager-Registered Nurse (RN)-PRNTexasCollaborates with the physician and all members of the interprofessional health care team to facilitate care for designated case load; monitors the patient’s progress, intervening as needed to ensure that the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective; facilitates timely: • completion and reporting of diagnostic testing; • completion of treatment plan and discharge plan; • modification of plan of care, as necessary, to meet the ongoing needs of the patient; • assignment of appropriate levels of care; • completion of all required documentation in EPIC and MIDAS. Identifies when services no longer meet InterQual/Millman l criteria, initiates discussion with attending physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from the physician advisor, if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage.
Case Manager / RN (PRN) Houston MethodistCase Manager / RN (PRN)PEOPLE ESSENTIAL FUNCTIONS Collaborates with the physician and all members of the interprofessional health care team to facilitate care for designated case load; monitors the patient’s progress, intervening as needed to ensure that the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective; facilitates timely: • completion and reporting of diagnostic testing; • completion of treatment plan and discharge plan; • modification of plan of care, as necessary, to meet the ongoing needs of the patient; • assignment of appropriate levels of care; • completion of all required documentation in EPIC and MIDAS. Identifies when services no longer meet InterQual/Millman l criteria, initiates discussion with attending physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from the physician advisor, if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage.
NewSCO RN UM Reviewer NeighborHealth CorpSCO RN UM ReviewerMA$44–$64 / hourThe successful candidate will be able to perform the following responsibilities: Communicates results of reviews verbally, in the medical record, and through official written notification to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements. Maintains consistent communication and collaboration with CCA UM team and SCO team relating to updates and program issues; ensures that Directors/Managers and peers are also informed of these matters.
MDS Coordinator - RN Oak Crest Village by Erickson Senior LivingMDS Coordinator - RNParkville, MD$100,000–$110,000 / yearSee Erickson Senior Living Privacy Policy at https://www.ericksonseniorliving.com/privacy-policy and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions. In this vital leadership role, you'll oversee the Resident Assessment Instrument (RAI) process, ensuring accurate and timely completion of MDS assessments from scheduling through final submission to both the MDS analysis vendor and CMS.
Medicine to MICU Registered Nurse Pathway Program Yale New Haven HealthMedicine to MICU Registered Nurse Pathway ProgramNew Haven, CTDesigned for Medicine RNs interested in critical care, this pathway provides mentorship from critical care leaders, immersive shadowing experiences, and targeted learning focused on ICU and step-down practice readiness. Develops, communicates and documents a plan of care reflecting individualized patient problems and interventions to achieve desired outcomes, involving the patient, family and healthcare team in this process.
Registered Nurse New Graduate Medicine Yale New Haven HealthRegistered Nurse New Graduate MedicineNew Haven, CTDevelops, communicates and documents a plan of care reflecting individualized patient problems and interventions to achieve desired outcomes, involving the patient, family and healthcare team in this process. The registered nurse (RN) assesses, plans, implements, evaluates, and supervises individual patient care on a nursing unit/department according to unit policies and procedures.
NewFull-Time Night Shift RN - 5.2 Med/Surg Resp/Renal Yale New Haven HealthFull-Time Night Shift RN - 5.2 Med/Surg Resp/RenalNew London, CTDevelops, communicates and documents a plan of care reflecting individualized patient problems and interventions to achieve desired outcomes, involving the patient, family and healthcare team in this process. The Registered Nurse (RN) assesses, plans, implements, evaluates and supervises individual patient care according to unit policies and procedures, including the PCU level patient.
NewFull-Time Day Shift RN - 5.2 Med/Surg Resp/Renal Yale New Haven HealthFull-Time Day Shift RN - 5.2 Med/Surg Resp/RenalNew London, CTDevelops, communicates and documents a plan of care reflecting individualized patient problems and interventions to achieve desired outcomes, involving the patient, family and healthcare team in this process. The Registered Nurse (RN) assesses, plans, implements, evaluates and supervises individual patient care according to unit policies and procedures, including the PCU level patient.
Per Diem NICU RN Yale New Haven HealthPer Diem NICU RNNew London, Connecticut2. Develops, communicates and documents a plan of care reflecting individualized patient problems and interventions to achieve desired outcomes, involving the patient, family and healthcare team in this process. Demonstrates competency in insertion and maintenance of neonatal peripheral intravenous lines, obtaining neonatal lab samples and maintenance of central intravenous lines.
New36H Day Shift NICU RN Yale New Haven Health36H Day Shift NICU RNNew London, Connecticut2. Develops, communicates and documents a plan of care reflecting individualized patient problems and interventions to achieve desired outcomes, involving the patient, family and healthcare team in this process. Demonstrates competency in insertion and maintenance of neonatal peripheral intravenous lines, obtaining neonatal lab samples and maintenance of central intravenous lines.
New24H Night Shift NICU RN Yale New Haven Health24H Night Shift NICU RNNew London, Connecticut2. Develops, communicates and documents a plan of care reflecting individualized patient problems and interventions to achieve desired outcomes, involving the patient, family and healthcare team in this process. Demonstrates competency in insertion and maintenance of neonatal peripheral intravenous lines, obtaining neonatal lab samples and maintenance of central intravenous lines.
Emergency Department Case Manager (RN) Baptist Healthcare System IncEmergency Department Case Manager (RN)Corbin, KYCase managers work collaboratively with physicians, nurses, social workers, patients, families, and community partners to assess patient needs, develop care plans, coordinate services, and facilitate safe transitions of care. A high level of communication with other members of the interdisciplinary team will be required to coordinate the continuum of care activities, ensuring optimum utilization of resources, quality outcomes related to transition of care service delivery and compliance with external review agencies' requirements.
NewRN Case Manager, CCH Community Health SystemRN Case Manager, CCHFresno, CACase management will include: educating patients about medication; encouraging adherence; promoting risk reduction and healthy lifestyle choices; and following up with patients to ensure medication is taken, appointments are made, and labs are completed. Education High School Diploma, High School Equivalency (HSE) or Completion of a CHS Approved Individualized Education Plan (IEP) Certificate required.
NewRegistered Nurse (Occupational Health Medical Reviewer) CetechsRegistered Nurse (Occupational Health Medical Reviewer)Springield, VARemoteCetechs is seeking experienced Registered Nurses (RNs) to support the Transportation Security Administration (TSA) Candidate Assessment and Review for Eligibility Support (CARES) program. Active, unrestricted Registered Nurse (RN) license in Virginia (or ability to obtain prior to start).
NewSenior Registered Nurse Integrated Resources, IncSenior Registered NurseMiami, FloridaFull timeReceives requests for authorization of services, including inpatient hospital admissions, inpatient rehabilitation services, Skilled Nursing admission), home care home infusion services, outpatient and/or inpatient elective surgery, and referrals for specialty physician consultation with non-participating physician offices. Job DescriptionResponsible for completing medical necessity reviews using KFHP policies and procedures, reviewing inpatient and outpatient elective procedures requiring prior authorization, inpatient hospital stays, and requesting, assessing and appropriately channeling/facilitating discharge planning requests Consistently applies medical health benefit policy and medical management guidelines to authorize services.
Nurse Specialist II, Clinical Denials Knowtion HealthNurse Specialist II, Clinical DenialsRemoteThe Appeals Nurse works with attorneys and claims representatives by reviewing and appealing claims when appropriate to overturn clinical denials from Medicare, Medicaid, and other third-party payers. Knowtion Health culture is inviting and competitive, embracing challenge and celebrating accomplishment; dedicated colleagues striving to provide quality results that have lasting impact.
NewClinical Care RN Integrated Resources, IncClinical Care RNHarrisburg, PennsylvaniaFull timeIT Life Sciences Allied Healthcare CRO(Direct) 732-844-8721 | (W) 732-549-2030 x 311 | (F) 732-549-5549"INC 5 0 0 0 's FASTEST GROWING, PRIVATELY HELD COMPANIES" (8th Year in a Row) Job DescriptionPosition Summary: Responsible for conducting timely reviews of all requests for services required to meet medical necessity criteria to include reviewing pre-certification for outpatient and inpatient services.
NewRN - Childrens Neonatal ICU Yale New Haven HealthRN - Childrens Neonatal ICUStamford, CTDevelops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And Supervises Individual Patient Care On A Nursing Unit/Department According To Unit Policies And Procedures.
UM BH Registered Nurse HumanaUM BH Registered NurseOlympia, WARemoteUse your skills to make an impact** **Required Qualifications:** + **You must be a transitioning service member eligible to participate in the DOW SkillBridge or a military spouse eligible to participate in the military spouse fellowship** · + Active Registered Nurse, RN, in the state of Kentucky or an enhanced Compact, (eNLC) license without restrictions or disciplinary action.· + **Minimum two, (2) years of clinical behavioral health experience.** + Proficiency in healthcare software and electronic medical records (EMR) systems. **Workstyle:** Remote Work at Home **Location:** Must reside in a state that participates in the enhanced compact license, (eNLC) **Work Schedule:** Weekdays 8:00 AM to 4:30 PM Central Time **Travel:** None **Additional Information** **Work At Home Requirements** + WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office.
Senior RN Clinical Care Navigation & Vendor Liaison Coordinator TexicareSenior RN Clinical Care Navigation & Vendor Liaison CoordinatorTexasYou will collaborate closely with customer experience, sales, employer groups, brokers, provider relations, network, compliance, and operational teams to navigate challenges related to care management, provider access, transitions of care, and utilization management services, while helping establish best practices and processes for the future. Working within a managed care environment that partners with delegated clinical vendors, you will act as a key liaison between the health plan, vendor clinical teams, and internal stakeholders to help resolve member care concerns and support a seamless healthcare experience.
Utilization Management Supervisor Non-Clinical UCLA Health SystemUtilization Management Supervisor Non-ClinicalLos Angeles, CA$70,900–$145,200 / yearb'nn n n n n n n n n n n n nn n n n n n n n n n n n n n n n n n Utilization Management Supervisor, Non-Clinical - - 31153 - UCLA Healthn n nnnn nn n n n nn n n n n Skip to content nn n n n n n UCLA Health Home Page n n nn nnn n nn n Main menu. Press enter or space keys to expands and escape key to collapse nn n n n n n n Sear...
RN Case Manager per-diem South Shore HealthRN Case Manager per-diemWeymouth, MA4 - The RN Case Manager is responsible for assessing patient acute level of care needs and works to implement and coordinate interventions aimed at facilitating a safe and timely discharge plan to the appropriate sub-acute settings in collaboration with the Case Manager Specialist. Required additional Knowledge, and Abilities Demonstrated skills in the areas of: negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking, time management and ability to multitask in high stress environment.
NewRN Case Management Coordinator BlueCross BlueShield of South CarolinaRN Case Management CoordinatorSouth CarolinaProvides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div.
NewCase Management Coordinator (RN or Social Worker) BlueCross BlueShield of South CarolinaCase Management Coordinator (RN or Social Worker)South CarolinaRemoteProvides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as social worker from the United States and in the state of hire (in Div.
Case Manager (Rn) - Inpatient - 0.8 Fte, 08-Hr, Day Shift Stanford Health CareCase Manager (Rn) - Inpatient - 0.8 Fte, 08-Hr, Day ShiftPalo Alto, CA$96.35–$111.14 / hourOther- Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned. Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration.
Case Manager (Rn) - Inpatient - 1.0 Fte, 08-Hr, Day Shift Stanford Health CareCase Manager (Rn) - Inpatient - 1.0 Fte, 08-Hr, Day ShiftPalo Alto, CA$96.35–$111.14 / hourOther- Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned. Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration.
NewCase Manager (RN) - Inpatient - 1.0 FTE, 08-HR, Day Shift Stanford Health CareCase Manager (RN) - Inpatient - 1.0 FTE, 08-HR, Day ShiftPalo Alto, CA$96.35–$111.14 / hourOther - Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned. Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration.
Case Manager (RN) - Inpatient - 1.0 FTE, 08-hr, Day Shift Stanford Health CareCase Manager (RN) - Inpatient - 1.0 FTE, 08-hr, Day ShiftPalo Alto, CA$96.35–$111.14 / hourOther - Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned. Monitors patients'' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient''s clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration.
Case Manager (RN) - Timely Discharge - 1.0 FTE, 8-HR, Day Shift Stanford Health CareCase Manager (RN) - Timely Discharge - 1.0 FTE, 8-HR, Day ShiftPALO ALTO, CA$96.35–$111.14 / hourOther - Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned. Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration.
RN Care Manager Acute Orlando Health Ventures l LLCRN Care Manager AcuteLakeland, FLOpening in summer 2026, Orlando Health Watson Clinic Lakeland Highlands Hospital - a state-of-the-art, seven-story, multi-specialty hospital - will serve as a vital 550,000 square-foot healthcare hub offering: 300+ inpatient beds and 69 emergency and observation beds 11 operating rooms and four cardiac interventional suites Dedicated labor and delivery services - including a neonatal intensive care unit (NICU) that will debut shortly after the hospital opens Comprehensive cardiovascular, neurology, and oncology services Advanced surgical procedures Join us in shaping the future of healthcare in Polk County as part of the Orlando Health Watson Clinic Lakeland Highlands Hospital opening team and share in the privilege of saying you were there from the very beginning. Shift: Second Shift 2pm-10pm Responsibilities nitially and concurrently assesses all patients within assigned population to include, but not limited to: Accurate medical necessity screening and submission for Physician Advisor review Care coordination that includes admitting diagnosis/ medical history, current treatments, age, payment source, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, special/ personal needs, and other relevant information.
Case Manager (RN) - Inpatient - 0.8 FTE, 08-hr, Day Shift Stanford Health CareCase Manager (RN) - Inpatient - 0.8 FTE, 08-hr, Day ShiftRedwood City, CA$96.35–$111.14 / hourOther - Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned. Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration.
Denials RN Coordinator Ensemble Health PartnersDenials RN CoordinatorOHRemote$62,500–$79,800 / yearJob duties include but are not limited to: understanding insurance contract terms, reviewing claim denials and underpayments to determine if additional payment amounts can be expected, analyzing medical records and determining if a member or an Independent Review organization (IRO) appeal is necessary, understanding payer medical policy guidelines, preparing IRO appeal documentation which may include correcting and resubmitting claims, gathering additional information, reviewing medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting provider, member and IRO/ALJ appeals in a timely manner. Extensive review of medical records for medical necessity criteria, filing written letters of appeal on denied claims, filing complaints with state Department of Insurance, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner.
NewRegistered Nurse (RN), Float Critical Care / ICU Yale New Haven HealthRegistered Nurse (RN), Float Critical Care / ICUYonkers, NYDevelops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And Supervises Individual Patient Care On A Nursing Unit/Department According To Unit Policies And Procedures.
RN, HCAT Administrator University of RochesterRN, HCAT AdministratorWorker Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 400166 Cancer Center M&D Work Shift: UR - Day (United States of America) Range: UR URCB 216 Compensation Range: $84,557.00 - $118,380.00 The referenced pay range represents the minimum and maximum compensation for this job. Collaborates with contacts in finance, contracting, department administration, legal, pharmacy, nursing, and medical ethics to ensure successful and financially sustainable FDA-approved gene- and cell-based therapy programs across all relevant clinical areas of the institution.
RN Ambulatory Care Manager Intermountain Health IncRN Ambulatory Care ManagerSt George, UT$41.20–$62.17 / hourFrequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations. Collaborating effectively with patients, families/caregivers, healthcare providers, payers, community-based providers, and other involved parties ensures efficient, effective, and patient-centered care management services.
RN or Social Worker, Case Manager: PRN Firelands Regional Medical CenterRN or Social Worker, Case Manager: PRNSandusky, OHWe are locally managed and governed as a not-for-profit healthcare facility, serving the counties of Erie, Ottawa, Sandusky, and Huron, covering a regional service area with over 300,000 residents. What You Will Do: Makes patient rounds with and without physician to evaluate and assess the needs of the patient, assigning a designated level of risk of identified barriers to plan of care and discharge/transition needs.
Inpatient RN Care Manager Advocate Aurora Health IncInpatient RN Care ManagerPark Ridge, IL$38.20–$57.30 / hourServes as an active member of the Outcome Facilitation Team/Patient Care Multidisciplinary Team and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities. Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays.
RN Or Social Worker, Case Manager: PRN Firelands Regional Medical CenterRN Or Social Worker, Case Manager: PRNSandusky, OHWe are locally managed and governed as a not-for-profit healthcare facility, serving the counties of Erie, Ottawa, Sandusky, and Huron, covering a regional service area with over 300,000 residents. What You Will Do: Makes patient rounds with and without physician to evaluate and assess the needs of the patient, assigning a designated level of risk of identified barriers to plan of care and discharge/transition needs.