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Oscar HealthNew
Overview
Perform medical necessity and level of care reviews using clinical judgment and evidence-based guidelines. Coordinate with care providers to assess member conditions and make recommendations on the appropriateness of care.
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Compensation
$35 - $46 / HOUR
Posted
New
TriHealthNew
The therapist conducts diagnostic clinical interviews, provides individual, family, child, and group therapy, and develops and implements written treatment plans. They also authorize services, coordinate with other agencies, and prepare timely clinical documentation.
Salary not listed
UF HealthNew
The specialist will act as the main contact for assigned managed care companies regarding negotiation and operational matters. This includes monitoring contract financial performance and ensuring payor compliance with all terms and conditions.
Vocational Instruction ProjectNew
The Entitlements Specialist manages Medicaid and HRA applications, ensures client eligibility, and maintains detailed filing systems for various programs. They also coordinate Fair Hearing appointments, manage EFSP funds, and act as a liaison with the Human Resources Administration.
$40,000 - $42,000 / YEAR
CVS HealthNew
The clinician provides comprehensive behavioral health assessments, care planning, and coordination of psychosocial services for members. They are responsible for managing complex clinical indicators and performing crisis interventions to ensure timely treatment.
$66,575 - $142,576 / YEAR
Provide telephonic clinical case management for the Medicare population through comprehensive assessments and individualized care plans. Collaborate with providers and internal partners to coordinate behavioral health resources and psychosocial services.
$60,522 - $129,615 / YEAR
Manage the transition of members from nursing facilities back into the community by developing member-centered care plans and coordinating safe discharges. Conduct face-to-face follow-up assessments and collaborate with interdisciplinary teams to reduce hospital readmissions.
$32 - $69 / HOUR
Southeast Medical GroupNew
The Primary Care Physician will provide comprehensive medical diagnostic, therapeutic, and preventive care to patients while managing individualized health programs. They are also responsible for supervising clinical staff, participating in peer reviews, and maintaining compliance with state medical regulations.
Physicians are expected to treat a wide range of medical conditions, develop long-term patient relationships, and create individualized healthcare programs based on historical data. Responsibilities also include supervising physician assistants/nurse practitioners and participating in quality improvement processes like peer review and risk management.
$220,000 - $250,000 / YEAR
Renfrew Center of New Jersey LLC
Conduct biopsychosocial assessments to determine appropriate levels of care and establish treatment goals for patients. Collaborate with outpatient providers and managed care companies to document clinical progress and discharge criteria.
2 days ago
Summit BHC
The Intake Clinician facilitates the admissions process by conducting clinical assessments and managing prior authorizations to ensure appropriate levels of care. They collaborate with medical staff and external parties to coordinate prompt patient entry and provide insurance benefit verifications.
Health Care Service Corporation
Conduct comprehensive medication reviews for high-risk Medicare members to improve drug therapy safety and effectiveness. Collaborate with multidisciplinary teams to address gaps in care, medication affordability, and adherence.
$102,000 - $184,300 / YEAR
Elevance Health
Investigate and process medical necessity appeals and member grievances, specifically focusing on Quality of Care cases. Prepare clinical summaries for Medical Directors and ensure all resolutions meet regulatory timeframes.
Mass General Brigham
Provide clinical and administrative support for ambulatory surgical practices, including patient rooming and procedure assistance. Manage patient flow, maintain sterile environments, and handle clinical messaging and scheduling within the Epic system.
$18 - $25 / HOUR
CenterWell
The Clinical Care Nurse will support transitions of care, reduce avoidable hospital readmissions, and drive quality performance metrics like Medicare Advantage Stars. They will conduct patient outreach, provide chronic disease education, and collaborate with interdisciplinary teams to optimize patient health outcomes.
$71,100 - $97,800 / YEAR
Harbor Health
The Social Worker supports the Utilization Management team by assessing psychosocial, behavioral health, and social needs to improve member health outcomes. They collaborate with nurses, providers, and community organizations to coordinate care and connect members to essential social services.
ChristianaCare
Provides clerical and administrative support to case managers and social workers to facilitate patient discharge planning. Responsibilities include verifying insurance benefits, coordinating with post-acute providers, and maintaining accurate clinical documentation.
$20 - $30 / HOUR
HHC
The Discharge Planner manages patient care plans, monitors resource utilization, and coordinates efficient discharge processes. They collaborate with the interdisciplinary team to ensure timely patient progression and resolve any barriers to discharge.
3 days ago
SSM Health
The Referral Coordinator II is responsible for coordinating provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans. This includes gathering clinical information, processing referrals, and ensuring compliance with insurance plan requirements.
Perform telephonic care management for members with complex and chronic needs by assessing, implementing, and monitoring personalized care plans. Coordinate internal and external resources and interface with Medical Directors to optimize member healthcare outcomes.
