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NorthBay Health
Overview
The Resource Specialist maximizes hospital resource utilization and coordinates post-hospital care or provides patient resources, primarily supporting Social Services, Inpatient Case Management, and Population Health teams. Key duties involve communication with payers and outside agencies to facilitate patient discharge and tracking resources provided for disposition.
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Compensation
$31 - $39 / HOUR
Posted
3 days ago
Corewell Health
The role involves planning and prioritizing care for individuals and patient populations to promote optimal health, utilizing expertise in nursing care and management of a caseload of varying complexity. Responsibilities include assessing patient needs, developing care plans, coordinating services across the continuum of care, and measuring patient care outcomes.
Salary not listed
24 days ago
USPI
The Case Manager facilitates patient progress through the continuum of care from pre-admission through discharge, providing feedback to payers on clinical status and securing necessary approvals for continued stay. This role involves monitoring quality standards, evaluating discharge planning needs, monitoring resource consumption, and acting as a Patient Advocate to resolve concerns.
2 months ago
MyMichigan Health
This role coordinates and completes all provider enrollment activities for new, locum tenens, and existing providers, communicating progress and issues to various stakeholders. Responsibilities include facilitating administrative enrollment activities, acting as a specialist in the complex enrollment process with decision-making authority, and demonstrating competency in the Visual Cactus database for reporting.
Lifepoint Health
The Utilization Review Specialist facilitates clinical reviews for all patient admissions and continued stays, analyzing records to determine the legitimacy of treatment and length of stay while interfacing with payers. This role involves advocating for patients with substance abuse or psychiatric disorders to secure necessary treatment coverage and assisting the treatment team with insurance requirements for continued stay and discharge planning.
KPC GLOBAL MEDICAL CENTERS INC.
The RN Case Manager reviews inpatients to determine admission and continued stay criteria, and is responsible for formulating discharge plans after interviewing patients and family members regarding their needs. This role involves collaboration with physicians, nursing, ancillary staff, and payers, along with documenting medical reviews in the QRS system for various financial classes.
$50 - $74 / HOUR
3 months ago
INSIGHT Surgical Hospital
The ED Utilization Review/Case Manager facilitates appropriate hospital resource use by verifying acute inpatient criteria and assisting with timely discharge needs. This role serves as a central communicator, collaborating with internal and external parties on discharge planning and utilization review activities.
UnitedHealth Group
The Specialty Pharmacist will provide high-touch support to patients with complex, specialty diseases, focusing on personalized care, enrollment, retention, and acting as a trusted resource throughout their therapy journey. Key duties include resolving drug-related issues, educating stakeholders, coordinating clinical and billing projects, and contributing to formulary and compliance efforts.
$91,700 - $163,700 / YEAR
The Population Health Medical Social Worker provides social services to high-risk capitated populations using a Population Health approach, involving communication and coordination with healthcare teams, payers, and outside agencies to link patients to appropriate services. This role facilitates integration with community resources and documents all assessments and interventions in the electronic health record.
$51 - $62 / HOUR
The Clinical Appeals Nurse investigates and processes medical necessity appeals from members and providers to payers, requiring research into standards, regulations, and policy to overturn or uphold denied claims. This role involves ensuring timely and accurate processing of all denials according to policies and requirements, and preparing cases for Medical Director review when necessary.
$52 - $62 / HOUR
UR Thompson Health
The main function involves retrieving and distributing department correspondence to remote associates and processing paper claims for those associates. The role also requires manual credit card payment processing and actively supporting departmental goals.
$19 - $22 / HOUR
ATC - Northwest
The RN Case Manager is responsible for coordinating patient care across the continuum to ensure services are safe, efficient, and cost-effective. This involves assessing patient needs, developing individualized care plans, facilitating transitions, and collaborating with various stakeholders to optimize patient outcomes.
$2,484 / WEEK
4 months ago
WakeMed Health & Hospitals
The Case Manager I is responsible for providing patient case management services, coordinating care plans, and acting as a communication link among various stakeholders. They work collaboratively to anticipate patient needs and ensure smooth transitions in care.
5 months ago
