Milliman Utilization Review Jobs in Usa
9,570 positions found — Page 19
Description
Our Registered Nurse Case Managers (RNCM) have been called to care when they’re needed most. At Interim HealthCare, you’ll support a full range of patient services to bring comfort and dignity to our clients.
What we offer our Registered Nurse Case Managers (RNCM):
· Competitive pay, benefits, and incentives.
· Truly flexible scheduling – a dedication to work/life balance – Full-time/ Part-time / PRN / Weekends
· Daily Pay option available
· No Overtime Required
· 1:1 patient care
Excited to hear more?
Working at Interim HealthCare means a career unlike any other. With integrity at the center of all we do, we know that when we support you and your community, you’ll change lives every day.
As a Registered Nurse Case Manager (RNCM), you will:
· Conduct In Person patient interviews and comprehensive physical assessments.
· Oversee the implementation and ongoing assessment of the patient’s plan of care through the management of home health aides, LPNs, RNs, and other caregivers.
· Communicate patient conditions and collaborate with appropriate providers to deliver care when patient needs evolve.
· Provide education to patients and families on proper home health care procedures. Ie. Wound care, IV administration, medication management.
· Work to decrease readmissions by promoting preventative care and ensuring continuity of care.
To 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
· Current CPR/AED/BLS/First Aid certification
· Reliable transportation to/from care sites and/or work locations.
· 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.
· OASIS experience preferred
· Practical trach and/or ventilator experience preferred, not required.
At Interim HealthCare, we know that being our best is non-negotiable – that’s why we treat your family like our own. 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. From our unmatched referral response times to our focus on quality improvement, the most beautifully complicated time of your life is our life’s work.
We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.
#Kentucky1
*Overview:*
Our mission is to create a great place to work and a great place to live. Join our team as a Speech Language Pathologist and contribute to our mission of enhancing the communication and swallowing abilities of individuals through speech therapy interventions. As a Speech Language Pathologist, you will play a vital role in assessing, diagnosing, and treating speech and language disorders to improve the quality of life for our patients.
*Position Purpose*
The primary purpose of this job position is to identify and meet the speech-language therapy and related service needs of each resident in accordance with physician orders and the resident plan of care as well as federal, state and local standards, guidelines and regulations to ensure that the highest quality of resident care is maintained at all times. The SLP assumes the authority, responsibility and accountability necessary to understand and carry out his or her assigned duties within the SLP scope of practice.
*Job Requirements*
* Must have graduated with a Master's degree of equivalent in Speech-language pathology from an accredited school and have a valid speech-language pathologist state license in good standing (based on state specific requirements). It is the responsibility of the employee to maintain active licensing/certifications throughout their time of employment;
* Previous therapy experience is preferred, with some of that experience in a long-term care facility;
* Must provide all necessary documentation in accordance with the company's new hire process to evidence eligibility for employment and pass a criminal background check; BLS CPR certification as required by state law, but recommended for all therapists.
* Must complete new hire orientation as required by company policy and participate in continuing education such as in-services, staff meetings, Relias training, etc.;
* Must possess excellent interpersonal skills, including the ability to communicate clearly and work well with others;
* Must possess excellent organizational, critical thinking, decision making, problem solving, prioritization of care and time management skills;
* Must possess the ability to communicate proficiently in English, both orally and in writing;
* Must be proficient in the use of technology, including and especially the use of computers and electronic health record programs;
* Must be willing to follow all federal, state and local laws and regulations as well as company policies and procedures and abide by the employee handbook, including but not limited to dress and grooming standards, time and attendance standards, drug and alcohol policy, respect and courtesy towards others, conduct self in an honest and ethical manner, etc.;
* Must have flexibility and availability to work outside of standard business hours, including weekends and holidays and travel to other sister facilities when needed;
* Must participate in and respond professionally to surveys and inspections conducted by government agencies;
* Must be able to perform physical tasks and operate equipment associated with the standard work and essential functions of a speech-language pathologist, including using visual, auditory and speaking skills sufficient to evaluate, diagnose and communicate with residents, using fine and gross motor skills inherent to the roles of a speech-language pathologist, standing or sitting for extended periods, lifting/carrying in excess of 50 pounds, or be able to be reasonably accommodated for any limitations;
* Must be able to cope with the mental and emotional stress inherent to the position, including working daily with residents in the geriatric, mentally ill, dementia, and disabled populations;
* Must be able to perform assigned tasks with a minimum of supervision and oversight and develop awareness for and a willingness to perform other tasks, as needed, without constant supervision;
* Must help foster and maintain an atmosphere of warmth, cheerfulness, enthusiasm and compassion, giving residents the quality of service you would want to receive.
*Summary of Principal Accountabilities*
* Optimize communication, cognitive-linguistic abilities and swallowing skills of residents by providing, directing and/or overseeing speech therapy screening of residents as appropriate, and evaluation and treatment of residents who may benefit from therapy services. The SLP develops the initial treatment plan of care with revisions to the plan of care as needed throughout the resident's stay.
* Comply with best practice industry standards as well as state and federal laws and regulations regarding accurate and timely billing in each resident's medical record.
* Maintain completeness of each assigned resident's medical record by completing all assigned evaluations, progress notes, discharge summaries, clarification orders, etc. according to posted schedules for the shift, making sure entries are timely, informative and accurate.
* Establish and maintain professional and positive working relationships with residents which reflects person-centered care. Honor the resident's rights and provide care in a manner that promotes resident dignity and privacy.
* Coordinate/collaborate on resident care with other members of the interdisciplinary and therapy teams. This may include attending or providing updates for resident care conferences and utilization review/case management meetings, reporting changes in resident condition or allegations of abuse, and making referrals to other members of the interdisciplinary and therapy teams as appropriate.
* Coordinate and oversee referral process for swallow studies with outside providers/specialists.
* Remain professionally informed and enhance clinical expertise as well as professional and management skills through interaction with managers, therapists and other professional staff, continuing education courses/trainings, and attendance at facility in-services and trainings. Implement new programs/techniques to enhance speech therapy rehabilitation services.
* Understand relevant payment models related to billing and treatment guidelines as well as clinically appropriate means/modes of delivery. Provide quality care that falls within the guidelines of reasonable duration and type of services.
* Help maintain cleanliness of work areas, break areas, linen closets, supply closets, etc.
* Perform other related duties as may become necessary or as directed by supervisor(s).
Pay: $55.00 - $65.00 per hour
Benefits:
* 401(k)
* 401(k) matching
* Continuing education credits
* Dental insurance
* Flexible schedule
* Health insurance
* Health savings account
* Opportunities for advancement
* Paid time off
* Relocation assistance
* Retirement plan
* Vision insurance
Language:
* English (Required)
License/Certification:
* Speech-Language Pathology License (Required)
Ability to Commute:
* Cut Bank, MT 59427 (Preferred)
Work Location: In person
POSITION SUMMARY/RESPONSIBILITIES
The nurse case manager coordinates, in collaboration with the patient and interdisciplinary team, the treatment/ plan of care for a patient within the acute episode of care. He/she proactively facilitates interventions to assure timely delivery of services, evaluates the effectiveness of interventions, tracks variances and/or barriers in the plan of care, and functions as the patient advocate to identify and communicate health care needs.
EDUCATION/EXPERIENCE
Bachelor's degree in Nursing is highly preferred. Three to five years nursing experience required. Work experience in case management, utilization review or hospital quality is preferred.
LICENSURE/ CERTIFICATIONS
Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred. Current American Heart Association, Basic Cardiac Life Support and/or Health Care Provider card preferred.
Doctor of Medicine | Family Practice
Location: Portage, WI
Employer: Adelphi Locums
Pay: Competitive weekly pay (inquire for details)
Start Date: ASAP
About the Position
LocumJobsOnline is working with Adelphi Locums to find a qualified Family Practice MD in Portage, Wisconsin, 53901!
Summary:
- Ref #: S-MD-9072362
- Profession: Physician
- Specialty: Internal Medicine / Family Medicine
- Job Type: Locum Tenens
- Location: Portage, WI
- Start Date: ASAP
- Duration: 26 weeks
- Schedule: , 07:00 AM-03:30 PM
- Rate: $155/hr
Requirements:
- MD or DO from an accredited medical school
- Board Certified or Board Eligible in Internal Medicine (IM) or Family Practice (FP)
- Active and unrestricted medical license
- Prior correctional healthcare experience strongly preferred
- Experience treating older adult populations with multiple co-morbidities
- Long-term care or chronic care management experience highly desirable
- Strong leadership, communication, and clinical judgment skills
Responsibilities
- Provide medical leadership and clinical oversight for all healthcare services within the facility
- Establish, implement, and monitor clinical policies, procedures, and standards of care
- Ensure compliance with state, federal, and correctional healthcare regulations
- Supervise, mentor, and support physicians and advanced practice providers
- Manage and review complex medical cases involving chronic disease and long-term care needs
- Collaborate with nursing, mental health, administrative, and security teams
- Participate in quality assurance, peer review, and performance improvement activities
- Address clinical risk management, utilization review, and medical grievances as needed
About Adelphi Locums
Adelphi Locums, a brand of Adelphi Staffing, provides locum tenens staffing solutions for healthcare facilities across the U.S., connecting them with qualified physicians, advanced practitioners, and other medical professionals for temporary coverage needs.
1713597EXPPLAT
Nurse Practitioner | Family Practice
Location: Maury, NC
Employer: Adelphi Locums
Pay: Competitive weekly pay (inquire for details)
Start Date: ASAP
About the Position
LocumJobsOnline is working with Adelphi Locums to find a qualified Family Practice NP in Maury, North Carolina, 28554!
Adelphi is seeking Nurse Practitioners/Physician Assistants to provide primary care and medical management of offenders at 2 correctional facilities in North Carolina.
Job Quick Facts:
- ID: BD-878-39
- Profession: Nurse Practitioner / Physician Assistant
- Specialty: Primary Care
- Job Type: Contract/Locum
- Contract Length: Ongoing
- Service Setting: Correctional
- Location: Maury & Lumberton, NC
- Coverage Type: Clinical/On-site
- Start Date: ASAP
- Shift Schedule: 40 hours per week
Requirements:
- NP/PA NC License
- DEA certification
- BLS certification
- ACLS certification
- BC/BE
Responsibilities:
- Perform vital signs assessment and obtain a comprehensive, relevant medical history from offenders.
- Conduct independent evaluations, diagnosis, and treatment of acute and chronic illnesses, injuries, and trauma, consistent with clinical scope and licensure.
- Manage and monitor chronic health conditions, ensuring continuity of care and adherence to evidence-based guidelines.
- Prescribe indicated medications, including narcotics and controlled substances, in accordance with physician supervision, DAC policy, and state/federal regulations.
- Administer approved immunizations and preventive care in compliance with facility's protocols.
- Provide patient education and counseling on medications, treatment plans, diet, weight management, substance use, and disease prevention.
- Refer patients to the supervising physician or clinical director for evaluation of complex conditions beyond the scope of the NP/PA role.
- Order, perform, and interpret diagnostic tests including labs, X-rays, EKGs, audiograms, and tympanometry to guide clinical decision-making.
- Perform routine and comprehensive physical examinations for diagnosis, intake, or chronic disease follow-up.
- Document all clinical encounters promptly and accurately in the HERO electronic medical record system using POMR format.
- Maintain compliance with all standards under the North Carolina Nurse Practice Act and facility policies, including timely reporting, quality assurance participation, and ethical care delivery.
- Participate in utilization reviews, quality improvement activities, and peer consultations as required.
About Adelphi Locums
Adelphi Locums, a brand of Adelphi Staffing, provides locum tenens staffing solutions for healthcare facilities across the U.S., connecting them with qualified physicians, advanced practitioners, and other medical professionals for temporary coverage needs.
1695636EXPPLAT
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
National certification (e.g.
CCRN, RNC, CEN, CNOR, OCN, ANCC, CAN, CPAN, CFRN, etc.) in related field is preferred.
Three years recent, full-time hospital experience preferred.
Work experience in case management, utilization review or hospital quality assurance experience is preferred.
Must complete a Clinical Documentation Improvement Course within specified time of hire date.
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 preferred.
Case Manager Certification (CCM or ANCC) is highly desirable.
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
National certification (e.g.
CCRN, RNC, CEN, CNOR, OCN, ANCC, CAN, CPAN, CFRN, etc.) in related field is preferred.
Three years recent, full-time hospital experience preferred.
Work experience in case management, utilization review or hospital quality assurance experience is preferred.
Must complete a Clinical Documentation Improvement Course within specified time of hire date.
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 preferred.
Case Manager Certification (CCM or ANCC) is highly desirable.
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
National certification (e.g.
CCRN, RNC, CEN, CNOR, OCN, ANCC, CAN, CPAN, CFRN, etc.) in related field is preferred.
Three years recent, full-time hospital experience preferred.
Work experience in case management, utilization review or hospital quality assurance experience is preferred.
Must complete a Clinical Documentation Improvement Course within specified time of hire date.
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 preferred.
Case Manager Certification (CCM or ANCC) is highly desirable.
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
National certification (e.g.
CCRN, RNC, CEN, CNOR, OCN, ANCC, CAN, CPAN, CFRN, etc.) in related field is preferred.
Three years recent, full-time hospital experience preferred.
Work experience in case management, utilization review or hospital quality assurance experience is preferred.
Must complete a Clinical Documentation Improvement Course within specified time of hire date.
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 preferred.
Case Manager Certification (CCM or ANCC) is highly desirable.
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
National certification (e.g.
CCRN, RNC, CEN, CNOR, OCN, ANCC, CAN, CPAN, CFRN, etc.) in related field is preferred.
Three years recent, full-time hospital experience preferred.
Work experience in case management, utilization review or hospital quality assurance experience is preferred.
Must complete a Clinical Documentation Improvement Course within specified time of hire date.
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 preferred.
Case Manager Certification (CCM or ANCC) is highly desirable.
