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Highmark Health
Overview
The Case Manager is responsible for creating, implementing, and evaluating patient care plans while collaborating with interdisciplinary teams to optimize outcomes. They also manage readmissions, length of stay, and ED utilization while advocating for the needs of patients and their families.
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Compensation
Salary not listed
Posted
1 month ago
Acadiana Treatment Center
The Utilization Review Specialist acts as a liaison between managed care organizations and clinical staff, conducting reviews according to certification requirements and coordinating communication regarding reimbursement. This role involves monitoring patient length of stay, gathering utilization data, conducting quality reviews for medical necessity, and facilitating peer reviews.
$31 - $50 / HOUR
2 months ago
Mount Sinai Health System
The Case Manager is responsible for all aspects of case management for an assigned patient group, focusing on determining the appropriateness of the Level of Care and developing the plan of care. This role involves active participation in clinical initiatives aimed at reducing length of stay, improving efficiency, quality, and resource utilization.
Marshall Health Network
The Registered Nurse is responsible for the daily planning, coordination, and monitoring of patient care in collaboration with nursing staff and other healthcare professionals. This role involves ensuring effective resource utilization, maintaining established standards of care, and meeting patient outcomes within appropriate lengths of stay.
UHS
The Utilization Review Coordinator gathers and coordinates patient information for internal and concurrent reviews with insurance companies, negotiating and advocating on behalf of the patient and hospital. Key duties include assessing the appropriate level of care, reviewing discharges, completing continued stay reviews, and handling pre-certifications to ensure timely completion of daily workloads.
Hackensack Meridian Health
The Care Coordinator is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment and discharge plan for a designated caseload. This involves assessing patient needs, planning care in collaboration with the multidisciplinary team, and arranging appropriate next levels of care, including overseeing interfacility transitions.
$44 / HOUR
The RN UM Case Manager is responsible for promoting appropriate Length of Stay and resource management by assessing patient care needs upon entry and facilitating progression through the continuum of care. This involves collaborating with the healthcare team to plan and implement a care plan that enhances service excellence, quality clinical outcomes, and cost-effectiveness.
Seven Hills Hospital
The Utilization Specialist proactively monitors service utilization to optimize facility reimbursement by acting as a liaison between managed care organizations and clinical staff. Key duties include conducting utilization reviews, monitoring length of stay, gathering utilization data, facilitating peer reviews, and managing the formal appeal process for denials.
Indiana Regional Medical Center
The coordinator establishes and maintains efficient methods to ensure appropriate patient length of stay, including daily review of patient progress and follow-up on discharge planning. This role also involves collecting and maintaining data, compiling monthly reports, and assisting the case management team with monitoring trends and insurance authorizations.
4 months ago
