- City of New York (New York, NY)
- …lien re-payment. OLR/OLT is recruiting for (1) one Supervisor of Nurses to function as a Complex Medical Case Reviewer , who will: - Conduct medical ... to calculate injury related Medicaid liens pursuant to SSL-104b on cases involving Medical malpractice, mass medical torts, lead paint poisoning, traumatic brain… more
- Prime Healthcare (Newark, NJ)
- …readiness for, and adherence to complex HIV/AIDS treatments. Medical case management also includes client-specific advocacy and review of use of ... clinical team with resources, information, and performs the various steps of medical case management including completion of intakes, psychosocial assessments,… more
- Point32Health (MA)
- …The Clinical Reviewer is responsible for making the determination of medical necessity and, therefore, benefit coverage for Commercial members. The Clinical ... benefit determinations using applicable coverage documents, purchased clinical guidelines or Medical Necessity Guidelines for clinically complex services /… more
- Centers Plan for Healthy Living (Margate, FL)
- …plans they need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial Adverse ... RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063,...standards and policy and procedures. Investigation and preparation of case narratives and statements of position based on clinical… more
- Kepro (Lombard, IL)
- …clinical operations. + Represent the organization through state appeal processes. + Review medical information trends, experiences, and approaches and assist in ... in the public sector. Acentra seeks a Psychiatrist Physician Reviewer (Illinois Remote, PRN) to join our growing team....and clinical expertise to operations relating to the peer review process, utilization review activities, and other… more
- The Cigna Group (Bloomfield, CT)
- …delegated tasks assigned by a supervisor in Utilization Management. Handles moderately complex medical review , utilization review , ... the following: + Laboratory molecular and genetic testing clinical case review activities. + Evaluate telephone, fax,...Strong interpersonal skills with the ability to clearly explain complex medical information in both verbal and… more
- Point32Health (MA)
- …of care. To facilitate coordination and integration of behavioral health, medical management, and case management services. KEY RESPONSIBILITIES: Conduct ... the treatment process. Identify through proactive concurrent reviews high-risk/high cost complex members for internal case management, and make appropriate… more
- Hildebrand Self-Help Center (Cambridge, MA)
- …Coordinate client care plans with hospital social workers for complex client medical issues. * Support Case Managers, ensuring clients are connected to ... an approach and internal system for dealing with client's complex medical issues. * Provide greater context... complex bureaucracies. * Focus on the most complex or unique cases where standard case … more
- University of Michigan (Ann Arbor, MI)
- Complex Case Manager Apply Now **Job Summary** Complex Care Managers provide comprehensive care management services to Michigan Medicine patients with ... complex medical and psychosocial needs. They possess...employer. **Job Detail** **Job Opening ID** 245091 **Working Title** Complex Case Manager **Job Title** Case… more
- Kepro (Bloomington, IN)
- …a vital partner for health solutions in the public sector. Acentra seeks an RN Complex Case Manager in Greene, Sullivan, Knox, Clay, and Vigo counties Job ... Summary: The RN Complex Case Manager will: + Provide in-home,...continue the plan of care and support transition. + Review the care plan and progress in regular care… more