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for review and determination. Works closely with the Medical Director to ensure that Medical review of specific cases occurs timely and meets standards for decision turnaround time Addresses all complaints and grievances according to...
Assumes a leadership role within Medical Management for high risk members and providers to insure high quality, ... data collection and reporting. Oversees the provision of Medical Management functions which include: organizing and...
Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided Coordinates and ... required Comprehensive benefits for temporary employees include: Medical/Dental/Vision Life Insurance/Disability...
The RN Manager of Appeals supervises the day-to-day activities of the department which include supervising the clinical and non-clinical Appeals and Grievances staff as well as implementing, maintaining and monitoring Appeals &Grievances...
years experience with CHHA, Long Term Care, Lombardi Program,Oasis documentation andmedicare regulations Supervisory experience required Comprehensive benefits for temporary employees include: Medical/Dental/Vision Life...
Determine patient eligibility as established by the Long Term Home Health Care Plan (LTHHCP) criteria, which may include a home visit for assessment purposes Collaborate with physician, patient, and family to establish and revise as...
We are looking for a Registered Nurse ICD-10 Project Manager to coordinate all implementation activities in accordance with the budget, timelines and values defined by the ICD-10 Program. Managing the project workflow and life cycle to...
Responsible for oversight of our external vendor who handles enrollment, fulfillment (Summary of Benefits, Evidence of Coverage, Annual Notice of change, letters, etc., claims processing, and provider calls Run the Medicare Compliance...
(oversight of scheduling, clinical consultations, staffing) of teams of Intake and Reassessment Nurses: ... all aspects of personnel management, including maintaining staffing patterns, to ensure appropriate orientation,...
Nurses Direct the daily operations of scheduling, staffing needs, clinical coordination. Participates in the ... all aspects of personnel management, including maintaining staffing patterns, to ensure appropriate orientation,...
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