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Elevance HealthNew
Overview
The Nurse Case Manager I performs care management for members with complex and chronic needs by assessing, implementing, and monitoring personalized care plans. Responsibilities include coordinating internal and external resources and collaborating with Medical Directors to optimize member health outcomes.
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Compensation
$70,000 - $105,000 / YEAR
Posted
New
Infucare Rx Inc on behalf of itself and its subsidiariesNew
The Intake Authorization Coordinator facilitates all intake phases, including benefits verification, authorization, and patient financial counseling, while coordinating interactions with various internal and external stakeholders. This role involves performing duties in accordance with company policy, professional standards, and regulatory requirements, including completing administrative tasks within the pharmacy management system.
$55,000 - $60,000 / YEAR
The Pharmacist will coordinate and facilitate patient care by reviewing orders, monitoring drug therapy outcomes, and collaborating with healthcare professionals. They are also responsible for the preparation of sterile admixtures and ensuring compliance with all pharmacy laws and standards.
Salary not listed
BMC Software
The Specialty Clinic Pharmacist manages enrollment and prescription adherence for patients in specialty care management. They provide clinical support to specialty clinics, conduct medication therapy reviews, and collaborate with healthcare providers to ensure continuity of therapy.
$112,000 - $162,500 / YEAR
6 days ago
Elevance Health
Collaborate with healthcare providers and consumers to drive personalized health management and improve outcomes for members with complex needs. Assess medical necessity for admissions and services while developing and monitoring individualized care plans.
8 days ago
Prime Therapeutics
The Physician Clinical Reviewer provides timely medical review of service requests that do not meet initial medical necessity guidelines, routinely interacting with physicians and staff. Responsibilities include discussing determinations with requesting providers, providing clinical rationale for appeals, and ensuring consistency using medical review guidelines.
$91 - $154 / HOUR
The Physician Clinical Reviewer conducts timely medical reviews of service requests that do not meet initial necessity guidelines. They also provide clinical rationale for appeals and act as a resource for the utilization management team.
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, requiring routine interaction with physicians and management staff. Responsibilities include discussing determinations with requesting providers within regulatory timeframes and providing clinical rationale for standard and expedited appeals.
Memorial Hermann Health System
This role is responsible for the front-line coordination of system-wide credentialing, ensuring accurate and timely processing of provider applications, managing daily workflow, and preparing necessary documentation for committee meetings. Key accountabilities include coordinating department workflow, preparing audit information, attending committee meetings, and overseeing training related to credentialing tools.
10 days ago
This role is responsible for the front-line coordination of system-wide credentialing functions, ensuring accurate and timely processing of provider applications through daily workflow management and meeting preparation. Key accountabilities include coordinating department workflow, preparing audit information, attending committee meetings, and onboarding new staff regarding credentialing tools and procedures.
The Nurse Case Manager I performs care management for members with complex and chronic needs by developing and monitoring individualized care plans. Responsibilities include coordinating internal and external resources and interfacing with Medical Directors to optimize member health outcomes.
$67,000 - $84,000 / YEAR
14 days ago
Hoag
The UM Nurse determines the medical necessity of inpatient admissions and continued stays based on evidence-based guidelines. They are also responsible for reviewing incoming referrals and authorization requests for clinical appropriateness and standards of care.
$50 - $78 / HOUR
16 days ago
St. Charles Health System
The Credentialing Coordinator manages the processes for medical staff, advanced practice professional, delegated payer, and allied health professional credentialing and privileging to ensure compliance with all legal and regulatory requirements across facilities. This role involves collecting and preparing detailed information, investigating potential quality of care issues, and maintaining accurate provider files in company software.
$25 - $38 / HOUR
24 days ago
Federal Hearings And Appeals
The Physician Peer Reviewer is responsible for reviewing medical case files and making medical determinations regarding medical necessity and appropriateness. This includes analyzing Federal and State laws, regulations, and applicable policy guides.
LUX Infusion
The Clinical Pharmacist is responsible for verifying prescriptions, conducting clinical reviews of patient therapies, and ensuring safe medication dispensing. They also collaborate with internal teams to support patient onboarding and maintain compliance with federal and state pharmacy standards.
$130,000 - $140,000 / YEAR
27 days ago
Avera Health
Assists in the preparation, distribution, and inventory management of medications under the supervision of a registered pharmacist. Responsible for obtaining patient medication histories and providing education to improve health outcomes.
1 month ago
Curant Health
Manage the prescription fulfillment process, ensuring accurate dispensing of medications in accordance with laws and policies. Act as a clinical resource for patients and healthcare professionals regarding medication therapy and drug information.
Akahi Associates/Kako'o Services, LLC
The Registered Nurse Case Manager coordinates comprehensive care for active duty patients and their families within a clinic setting. Responsibilities include developing patient-specific plans of care, advocating for resources, and collaborating with interdisciplinary teams and community agencies.
$35 - $45 / HOUR
Sutter Health
The Pharmacy Technician will manage medication preparation, distribution, and prior authorizations while ensuring compliance with regulatory standards. They will also coordinate patient care, manage inventory, and assist patients with financial aid programs.
$38 - $47 / HOUR
Provides comprehensive disease management services and health promotion strategies for patients with chronic conditions. Collaborates with multidisciplinary healthcare teams to implement evidence-based clinical practice guidelines and evaluate patient outcomes.
