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Alignment Health
Overview
Review prior authorization requests for medical necessity using CMS and MCG guidelines to ensure high-quality, cost-effective care. Collaborate with providers and medical directors to process referrals and manage appeals and grievances.
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Compensation
$77,905 - $116,858 / YEAR
Posted
23 days ago
Delmar Gardens of O'Fallon
The role involves performing day-to-day resident care duties under the supervision of nursing staff, including assisting with personal care needs, serving food, and promptly responding to resident needs and call lights. Responsibilities also include maintaining resident rights and confidentiality, following work assignments, and cooperating with inter-departmental personnel.
Salary not listed
24 days ago
Hoag
The Quality Management Nurse prepares, reviews, and presents findings on quality management events and grievances submitted to various medical directors and committees according to established policies. This role involves tracking grievances until final determination, documenting all activities, and participating in quality management projects, including HEDIS record collection and process improvement activities.
$49 - $76 / HOUR
1 month ago
InnovAge
The Social Worker plans and implements social work services, conducting psychosocial assessments and coordinating care within an interdisciplinary team. They act as a primary liaison for participants and families, managing transitions, end-of-life activities, and ensuring compliance with regulatory standards.
A&I Avenues
The Intake Case Manager serves as the initial contact for individuals with disabilities seeking community-based support, managing a caseload to ensure program fit and eligibility compliance. Responsibilities include conducting assessments, coordinating funding, educating clients on rights, and maintaining accurate documentation within regulatory guidelines.
$23 / HOUR
2 months ago
AdamsPlace
Responsibilities include working with individual patients and families to adjust to center life and crises such as illness, disability, and death, while also serving as an advocate for patients and their families in resolving grievances. The role also involves coordinating discharge planning and participating in developing patient care plans with other disciplines.
Responsibilities include exhibiting strong clinical and customer service skills while working with individual patients and their representatives to facilitate transition back to the community or adjustment to center life. The role also involves coordinating the patient's plan of care with the interdisciplinary team and reporting case management status to the Director of Social Work.
CareSource
The Nurse Care Manager provides care coordination including in-home assessment, planning, facilitation, advocacy, and authorization of covered plan services to meet member health needs while promoting quality cost-effective outcomes. This involves ensuring consistent care across the continuum, collaborating with various stakeholders, and assessing members for ongoing eligibility for services.
$100,000 - $160,000 / YEAR
3 months ago
The Admissions Coordinator will manage the center's admissions process, including handling inquiries, conducting patient needs assessments, and considering alternatives if the center cannot meet needs. This role also involves sharing funding resource information and supporting patients and families through adjustment to center life, illness, and death.
Olmsted Medical Center
This role facilitates the resolution of complaints, grievances, and requests for patients and visitors, documenting all concerns, actions taken, and outcomes in a tracking database. Responsibilities also include coordinating resolution with managers, assisting patients in understanding their care process, and identifying service issues to recommend improvements.
$39 - $54 / HOUR
4 months ago
The Social Worker will engage with patients and families to facilitate adjustment to center life and manage crises related to illness, disability, and death. Key duties include serving as an advocate, coordinating discharge planning, and participating in the development of patient care plans.
Atrium Place Health and Rehabilitation
The Registered Nurse is responsible for ensuring efficient and effective nursing care delivery, aiming for positive clinical outcomes and resident/family satisfaction according to established standards and regulations. This role involves directing nursing care during shifts, including assigning tasks, mentoring staff, and collaborating with medical professionals.
5 months ago
Stockton Nursing Center
This role involves meeting with various staff to plan social services, participating in discharge planning, and ensuring residents and their representatives are involved in care plan development. The assistant will also educate staff on Resident's Rights and manage resident grievances and complaints.
$21 - $23 / HOUR
PRIORITY MANAGEMENT
The Social Worker will assist in planning and implementing social service programs and participate in discharge planning and resident assessments. They will also coordinate with other departments and interpret residents' needs to the medical staff.
