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Emory Healthcare
Overview
Conduct medical necessity reviews for inpatient and observation admissions using Milliman and Interqual guidelines to ensure appropriate status designation. Coordinate with physicians and payers to maximize reimbursement and reduce financial risk through timely communication and documentation.
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Compensation
Salary not listed
Posted
9 days ago
Duke Health
Manage a designated caseload to coordinate assessments, discharge plans, and care transitions for behavioral health patients. Collaborate with multidisciplinary teams to ensure optimum resource utilization and compliance with CMS regulations.
SolutionHealth
The specialist evaluates medical acuity to ensure appropriate level of care orders and documentation to facilitate insurance coverage and prevent denials. They also review appeal options for medical necessity denials and ensure compliance with CMS and commercial insurance guidelines.
24 days ago
Duke Careers
Manage a designated caseload to coordinate assessments, discharge plans, and care transitions for behavioral health patients. Facilitate multidisciplinary communication and provide education to patients and families to ensure safe community living.
25 days ago
The role involves managing a designated caseload to coordinate and complete timely assessment, planning, implementation, and evaluation of discharge plans and care transitions across the continuum of care. Responsibilities include monitoring daily census, maintaining communication with the healthcare team, arranging necessary post-discharge services, and ensuring compliance with external review agencies.
27 days ago
Legacy Health
Coordinates and facilitates interdisciplinary, patient-centered care across the healthcare continuum for patients with acute and chronic conditions. Serves as an expert resource for the healthcare team regarding best practices, regulatory requirements, and efficient resource utilization.
$54 - $81 / HOUR
1 month ago
Independence Health System
The Case Manager is responsible for conducting utilization reviews, managing patient care plans, and facilitating appropriate discharge planning in collaboration with the healthcare team. They also handle denial management, educate staff on managed care standards, and ensure accurate documentation of patient resource utilization.
Purple Cow Recruiting
The RN Case Manager will perform utilization reviews, coordinate patient care, and manage discharge planning for adult and geriatric patients in an acute care setting. They will ensure compliance with regulatory requirements and facilitate communication between physicians, social services, and insurance providers.
The RN Case Manager will perform utilization reviews using InterQual criteria and coordinate patient care, including discharge planning and admission reviews. They will collaborate with interdisciplinary teams to manage individualized care plans and facilitate insurance authorizations within an acute care setting.
Coordinates and facilitates interdisciplinary, patient-centered care across the healthcare continuum for patients with acute and chronic conditions. Serves as an expert resource for the healthcare team regarding best practice protocols, regulatory requirements, and efficient resource utilization.
Sarasota Memorial Health Care System
The Clinical Case Facilitator manages the health status of the member population under the direction of the Medical Director. They oversee medical care throughout the continuum of care for the assigned patient population.
Trinity Health
The Registered Nurse ensures efficient, safe, and quality-driven discharge planning for patients throughout their acute episode of care. They serve as a liaison between the hospital and community agencies while collaborating with the multi-disciplinary team to facilitate effective transitions.
COMMUNITY HEALTH GROUP
The Case Manager assesses, plans, and coordinates optimal care delivery for members while ensuring services meet clinical guidelines and regulatory standards. They review requests for medical necessity, monitor utilization, and collaborate with providers to facilitate effective transitions and discharge planning.
$85,112 - $100,007 / YEAR
OSS Health
Conduct inpatient pre-admission and admission reviews using clinical criteria to ensure appropriate level of care and regulatory compliance. Collaborate with medical staff and care teams to manage patient progression, documentation, and discharge planning.
Tohono O'odham Nation Healthcare
The Nurse Case Manager provides comprehensive nursing care and manages patient referrals for specialty and hospital-based services. They are responsible for utilization review, coordinating discharge plans, and tracking high-cost cases to ensure appropriate care delivery.
2 months ago
Stony Brook University
The role involves completing utilization reviews for inpatient and observation cases, ensuring patients are in the correct level of care, and managing authorization processes for inpatient stays. Duties also include developing safe discharge plans, documenting avoidable delays, and actively participating with physicians and payers to prevent denials.
$88,000 - $125,466 / YEAR
Sentara Health
The Physician Advisor conducts timely and compliant medical necessity reviews and manages denials, including facilitating peer-to-peer discussions and writing appeal letters to support the centralized Utilization Review process for hospital facilities. This role also involves direct communication and education with attending physicians regarding status changes, regulatory requirements, and documentation integrity to support medical necessity.
Southern California Hospitals
The RN Case Manager performs clinical assessments, utilization reviews, and resource management to ensure safe and cost-effective patient care. They collaborate with the interdisciplinary team to facilitate discharge planning and coordinate transitions of care.
$69 / HOUR
3 months ago
The role involves conducting inpatient pre-admission, admission, and continuing stay reviews for various insurance beneficiaries using established criteria to ensure appropriate level of care and resource utilization. Responsibilities also include consulting with medical staff, resolving progression-of-care barriers, and ensuring compliance with regulatory notices like HINN, MOON, and ABN.
Island Health
The Case Manager coordinates patient care, facilitates safe discharge planning, and performs utilization reviews to ensure cost-effective outcomes. They collaborate with interdisciplinary teams, patients, and families to assess needs and connect them with appropriate community resources.
$35 - $53 / HOUR
4 months ago
