Milliman Utilization Review Jobs in Usa
12,087 positions found — Page 18
Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION
Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION
Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION
Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
POSITION SUMMARY/RESPONSIBILITIES Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary.
Will monitor opportunities within the Medicare managed group to enhance financial outcomes.
Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum.
Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs.
Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
Three years recent, full time hospital experience preferred.
Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required.
National certification in related field is desirable.
Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable.
Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
POSITION SUMMARY/RESPONSIBILITIES Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary.
Will monitor opportunities within the Medicare managed group to enhance financial outcomes.
Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum.
Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs.
Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
Three years recent, full time hospital experience preferred.
Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required.
National certification in related field is desirable.
Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable.
Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
*5, 40hr/wk.
Pay Range: $60/hr.
- $65/hr.
Stipends available for Traveler.
Locals are also accepted at reasonable pay.
Job Description: Coordinate patient care plans and ensure efficient resource utilization.
Perform comprehensive patient assessments and care planning.
Manage discharge planning and ensure continuity of care.
Collaborate with interdisciplinary teams for patient management.
Monitor compliance with external review agencies and regulatory standards.
Advocate for patients and address holistic care needs.
Support utilization review and case management functions.
Required Qualification: RN License of FL state or Compact.
BLS(AHA) is required.
2 years of Case Management Experience in Acute Care/ Hospital/ LTAC Setting.
POSITION SUMMARY/RESPONSIBILITIES Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary.
Will monitor opportunities within the Medicare managed group to enhance financial outcomes.
Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum.
Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs.
Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
Three years recent, full time hospital experience preferred.
Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required.
National certification in related field is desirable.
Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable.
Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
POSITION SUMMARY/RESPONSIBILITIES Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary.
Will monitor opportunities within the Medicare managed group to enhance financial outcomes.
Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum.
Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs.
Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
Three years recent, full time hospital experience preferred.
Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required.
National certification in related field is desirable.
Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable.
Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION
Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION
Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
