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TotalMed Staffing

40 đź’Ľ TotalMed Staffing Jobs / Employment

RN Field Care Manager - New Port Richey

newabout 1 hour ago
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Hours: 8am-5pm Monday-Friday Location: Remote/Field based JOB SUMMARY Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member. Coordinates, monitors and ensures that appropriate and timely primary, acute and long-term care services are provided to members across the continuum of care. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. Coordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works directly with the member in the field, i.e., inpatient bedside, member's home, provider's office, hospitals, etc. while collaborating with management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.

Utilization Review Nurse, (RN) - Grand Rapids

newabout 4 hours ago
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Job Description Provides Health Information, interacts and acts as a resource for nursing units for complex clinical situations to ensure appropriate use of acute care and diagnosis related group (DRG) management Assess appropriateness of inpatient admissions and continued stay. Educates medical staff/other health care professionals regarding utilization management and quality requirements. Makes recommendations and provides financial and utilization management information to other members of the care Facilitation teams for work prioritization. Works closely with inpatient care facilitators and medical social workers to move patients through the continuum appropriately Qualifications Licensed Registered Nurse (RN) Utilization Management (UM) experience 2 years of related experience in acute care and or a clinical background Working knowledge of InterQual and Electronic Medical Records (EMR) experience Position Overview Monday-Friday 8-5 3 week training period on site in Grand rapids, MI. Followed by remote possibility Full-time, 40 hours a week Job Type: Full-time Salary: $34.00 to $36.00 /hour

Utilization Review Nurse, (RN)

newabout 8 hours ago
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Job Description Provides Health Information, interacts and acts as a resource for nursing units for complex clinical situations to ensure appropriate use of acute care and diagnosis related group (DRG) management Assess appropriateness of inpatient admissions and continued stay. Educates medical staff/other health care professionals regarding utilization management and quality requirements. Makes recommendations and provides financial and utilization management information to other members of the care Facilitation teams for work prioritization. Works closely with inpatient care facilitators and medical social workers to move patients through the continuum appropriately Qualifications Licensed Registered Nurse (RN) Utilization Management (UM) experience 2 years of related experience in acute care and or a clinical background Working knowledge of InterQual and Electronic Medical Records (EMR) experience Position Overview Monday-Friday 8-5 3 week training period on site in Grand rapids, MI. Followed by remote possibility Full-time, 40 hours a week Job Type: Full-time Salary: $34.00 to $36.00 /hour

jobs byAdzuna

RN Utilization Manager

newabout 8 hours ago
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Hours: Monday- Friday 8-5pm Job purpose : The Utilization management nurses role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays. Concurrent review of patient’s clinical information for efficiency Ongoing review of precertification requests for medical necessity Monitor the activities of clinical and non-clinical staff Coordinates patient’s discharge planning needs with the healthcare team Employ effective use of knowledge, critical thinking, and skills to: Advocate quality care and enhanced quality of life Prevent patient complications during hospital stay Advocate decreased hospital stay when appropriate Maintain accurate records of all patient related interactions Prepare monthly patient management and cost savings report Work in an intensive, fast-paced environment with minimal supervision Ability to stay organized and interact well with others in any situation Provide daily updates to Manager of Utilization Management for review Skills and Qualifications: • State licensure as a Registered Nurse (RN) • Minimum 2 years of prior experience in Utilization Management • Minimum 2 years of experience working with Managed Care Organizations

jobs byAdzuna

RN Case Manager

newabout 8 hours ago
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Hours : Monday-Friday 8:00-5:00pm Pay rate : $32-$40/hr Job Description: Responsible for health care management and coordination of members in order to achieve optimal clinical, financial and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitors member’s progress and services to ensure consistent cost effective care that complies with policy and all state and federal regulations and guidelines. • Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for members. • Conducts face to face or home visits as required. • Maintains department productivity and quality measures. • Manages and completes assigned work plan objectives and projects in a timely manner. • Develop, assess and adjust, as necessary, the care plan and promote desired outcome • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options • Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients • Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs • Provide patient and provider education • Facilitate member access to community based services • Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan • Actively participate in integrated team care management rounds • Identify related risk management quality concerns and report these scenarios to the appropriate resources • Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems Required experience: • RN License • Familiarity with NCQA standards, state/federal regulations and measurement techniques. • In depth knowledge of CCA and/or other Case Management tools

jobs byAdzuna

Concurrent Review Nurse RN

newabout 8 hours ago
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We are in urgent need of a Concurrent Review Nurse for a well-known health insurance company in Tempe Concurrent review nurse Position Purpose : Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care Conduct discharge planning Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems Direct care to participating network providers Participate in utilization management committees and work on special projects related to utilization management as needed Pay: $36/hr

jobs byAdzuna

Case Management Nurse (RN)

newabout 8 hours ago
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We are in urgent need of Nurse Case Manager (RN) for a well-known healthcare organization in the area. This position is responsible for coordinating and managing specific CenCal Health members for defined periods of time and/or post discharge transition from an inpatient setting (e.g. acute care hospital, skilled or long-term care facility) to ensure that member’s outpatient care is being coordinated and that all medically necessary services are being provided in a timely manner. In addition, this position requires the management of complex care members over longer periods as deemed appropriate, as well as seniors and persons with disabilities, and potentially preventable admissions. Responsibilities include but are not limited to: Coordinate the provision of quality and cost-effective health care services Coordinate care and services for members and effectively and efficiently implement and complete the care management process. This process involves health screening, assessment, planning, coordination of care, and monitoring of member’s progress and compliance Collaborate with the member, the member’s family or caretaker, primary care provider, and other health care providers Coordinate timely care transition from one level of care to another, such acute to SNF or SNF to home or other living arrangement as the member’s care needs change Effectively communicate and educate members about the health care delivery system and health plan benefits and limitations Identify care needs of the member, identify interventions, develop plan of care, implement necessary services, and establish timelines for case management services Effectively communicate verbally and in writing with primary care providers and other health care providers involved in the member’s care Adhere to Health Plan and department specific policies and procedures Required: Excellent written, oral and interpersonal communication skills Good computer literacy and skills Strong analytical and problem-solving skills Proficient multi-tasking and organization skills Understand complex health care regulations such as HIPAA Privacy Rule Ability to adhere to and apply principles and professional standards of practice established by the Case Management Society of America (CMSA) Knowledge of Medi-Cal and/or Medicare Advantage plans, managed care regulations, including benefits and contract limitations, delivery and reimbursement systems, and role of medical management activities Education and Experience · Current active, unrestricted California Registered Nurse License with a minimum two (2) years’ experience as a Registered Nurse · Valid California Driver’s License with a clean driving record needed · Proficient with computer and Microsoft Office, Word, Excel, PowerPoint · Strong organizational skills and excellent verbal and written communication skills · Desired: · Certification in case management, utilization review, or healthcare management · Prior UM/CM experience in a managed care setting Job Type: Full-time Salary: $70,000.00 to $108,000.00 /year

RN Field Care Manager

newabout 8 hours ago
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Hours: 8am-5pm Monday-Friday Location: Remote/Field based JOB SUMMARY Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member. Coordinates, monitors and ensures that appropriate and timely primary, acute and long-term care services are provided to members across the continuum of care. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. Coordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works directly with the member in the field, i.e., inpatient bedside, member's home, provider's office, hospitals, etc. while collaborating with management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.

jobs byAdzuna

Concurrent Review Nurse

newabout 8 hours ago
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Job Description Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations - Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings - Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care - Conduct discharge planning Educate providers on utilization and medical management processes - Provide clinical knowledge and act as a clinical resource to non-clinical team staff - Enter and maintain pertinent clinical information in various medical management systems Requirements Licenses RN 2 years of relevant experience Job Type: Full-time Salary: $30.00 to $33.00 /hour

jobs byAdzuna

Licensed Practical Nurse

newabout 9 hours ago
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Job: Licensed Practical Nurse Hours: M-F 8-5 Pay: 30/hour Location: Appleton, WI 12 week contract Job Summary: The primary responsibility of this position is to assist patients within a clinical setting Preferred Education and licensing: Active LPN License EPIC or EMR Expereince

jobs byAdzuna

Case Management Nurse (RN)

newabout 9 hours ago
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We are in urgent need of Nurse Case Manager (RN) for a well-known healthcare organization in the area. This position is responsible for coordinating and managing specific CenCal Health members for defined periods of time and/or post discharge transition from an inpatient setting (e.g. acute care hospital, skilled or long-term care facility) to ensure that member’s outpatient care is being coordinated and that all medically necessary services are being provided in a timely manner. In addition, this position requires the management of complex care members over longer periods as deemed appropriate, as well as seniors and persons with disabilities, and potentially preventable admissions. Responsibilities include but are not limited to: Coordinate the provision of quality and cost-effective health care services Coordinate care and services for members and effectively and efficiently implement and complete the care management process. This process involves health screening, assessment, planning, coordination of care, and monitoring of member’s progress and compliance Collaborate with the member, the member’s family or caretaker, primary care provider, and other health care providers Coordinate timely care transition from one level of care to another, such acute to SNF or SNF to home or other living arrangement as the member’s care needs change Effectively communicate and educate members about the health care delivery system and health plan benefits and limitations Identify care needs of the member, identify interventions, develop plan of care, implement necessary services, and establish timelines for case management services Effectively communicate verbally and in writing with primary care providers and other health care providers involved in the member’s care Adhere to Health Plan and department specific policies and procedures Required: Excellent written, oral and interpersonal communication skills Good computer literacy and skills Strong analytical and problem-solving skills Proficient multi-tasking and organization skills Understand complex health care regulations such as HIPAA Privacy Rule Ability to adhere to and apply principles and professional standards of practice established by the Case Management Society of America (CMSA) Knowledge of Medi-Cal and/or Medicare Advantage plans, managed care regulations, including benefits and contract limitations, delivery and reimbursement systems, and role of medical management activities Education and Experience · Current active, unrestricted California Registered Nurse License with a minimum two (2) years’ experience as a Registered Nurse · Valid California Driver’s License with a clean driving record needed · Proficient with computer and Microsoft Office, Word, Excel, PowerPoint · Strong organizational skills and excellent verbal and written communication skills · Desired: · Certification in case management, utilization review, or healthcare management · Prior UM/CM experience in a managed care setting Job Type: Full-time Salary: $70,000.00 to $108,000.00 /year

jobs byAdzuna

Utilization Management Nurse

newabout 9 hours ago
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We are in urgent need of a Utilization Management Nurse for a well-known healthcare organization in the area. We offer competitive pay and benefits Job Summary (General Overview, reporting to, work environment) The UM Nurse performs prospective, concurrent, and retrospective reviews for long- term care, acute inpatient, specialty referrals, medical services and durable medical equipment. The purpose and goals of utilization management are to assure that CenCal Health members receive medically necessary care at the appropriate place, with the appropriate provider, and at the appropriate level of care. This position is responsible for timely review of request for services and based on established clinical guidelines and/or benefits limitations, determine appropriateness of requested services. Responsibilities include: Accurate interpretation of established clinical guidelines Perform timely prospective review for services requiring prior authorization Perform timely concurrent review for inpatient care in the acute care, subacute, skilled nursing, and long-term care setting Perform timely retrospective review for services that required prior authorization but was not obtained by the provider Support and collaborate with the UM and CM Clinical Managers in the implementation and management of UM/CM activities Actively participate in the development, implementation and the evaluation of department initiatives with the intent to assess any measurable improvements to member’s quality of care Perform selective claims review, and occasional onsite review Adhere to regulatory time frames for completion of reviews Keep abreast of health care benefits and limitations, regulatory requirements, disease processes and treatment modalities, community standards of patient care, and professional nursing standards of practice Other duties as assigned Skills/Knowledge/Abilities · Excellent written, oral and interpersonal communication skills · Good computer skills with accurate data entry into an electronic health record · Ability to analyze medical documentation and apply criteria to determine medical necessity, acuity of care, severity of illness and intensity of service · Ability to multi-task, organize and prioritize workload, and complete assignments in a timely manner · Knowledge of managed care issues, including benefits and contract limitations, delivery and reimbursement systems, and role of medical management activities · Work independently or cooperatively, as a team leader and member · Ability to organize work effectively in a cross-functional team environment in a collaborative way · Ability to communicate by phone and in person (in both individual and group situations) and to clearly and effectively communicate and negotiate with members and families, physicians and other health care providers · Maintain consistent and predictable attendance. Maintain sufficient level of punctuality and attendance to meet job standards and requirements Education and Experience Required: · Current valid, unrestricted California Registered Nurse License · A minimum of one year experience as a Registered Nurse · Must be computer literate · Strong organizational skills and excellent verbal and written communication skills Desired: · Prior utilization and/or case management experience in an inpatient, clinic, health plan and/or managed care setting · Certification in utilization review or healthcare management · Certified Case Manager Job Type: Full-time

jobs byAdzuna

Concurrent Review Nurse

newabout 9 hours ago
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Hours: Monday - Friday; 8am - 5pm Pay: $40/hr Summary of position: - Complete computer based reviews of hospital stays - Send approval and denial letters - Handle discharge planning with Hospital staff - Work with administrative staff to assure smooth processing of authorizations - Work in large team to assure work is done daily Education/Experience: - Graduate from accredited School of Nursing - Bachelor's degree in Nursing preferred - 2 years of clinical nursing experience - Current state's RN license - High level of computer skills - Must be alright with no patient contact

jobs byAdzuna

Health Plan Registered Nurse (RN)

newabout 9 hours ago
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We are in urgent need of a Health Plan RN for a well-known healthcare organization in the area. This is an entry level nurse position in managed care. If you are a nurse looking to get out of bedside nursing and more into the business side of nursing, this is for you We offer competitive pay and benefits Job Summary (General Overview, reporting to, work environment) The Health Plan Registered Nurse is an entry level nurse position. Depending on department assignment, this position reports to the manager of one of three clinical operational departments, Utilization Management, Case Management (Adult) or Pediatric Care Coordination and will provide assistance, including but not limited to; review of request for services, coordination of care and services for members, developing and maintaining care plans or care transition. Required: Excellent written, oral and interpersonal communication skills Strong organizational and time management skills Good computer literacy especially with Microsoft Office programs As appropriate, understand adult or pediatric health conditions and disease processes As appropriate, able to accurately interpret and apply clinical and regulatory guidelines Understand HIPAA Privacy Rule Ability to work effectively in a cross-functional team environment in a collaborative way or independently Ability to quickly learn and use an electronic database, such as Essette, EPIC, HAX to document and summarize findings Preferred: Knowledge of Medi-Cal and/or Medicare health care benefits, managed care regulations, including benefits and contract limitations, delivery and reimbursement systems, and role of medical management activities Understand basic utilization review principles and practices Understand basic case management concepts and principles as described in the Case Management Society of America Job Type: Full-time

jobs byAdzuna

Nurse Case Manager

newabout 9 hours ago
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Looking For Previous CM or UM experience Acute care experience – med surg, ED, ICE Home health or hospice experience Strong computer skills Description Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care Conduct discharge planning Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems Direct care to participating network providers Participate in utilization management committees and work on special projects related to utilization management as needed For New Hampshire and Massachusetts - home visits required Qualifications Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2 years of clinical nursing experience and 1 years of utilization management experience in a managed care setting. Acute care experience preferred. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs

jobs byAdzuna

Concurrent Review Nurse (OB Experience required)

newabout 9 hours ago
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Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Job Responsibilities: -Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations -Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings -Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care - Conduct discharge planning Educate providers on utilization and medical management processes - Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred Current state’s LPN/LVN or RN license. 2 years of OB experience

jobs byAdzuna

Utilization Management Nurse

newabout 10 hours ago
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Hours : Monday - Friday; 8:30am-5pm Pay : $45/hr Position summary: - Performs on-site, written or telephonic assessments and utilization review, across the continuum of care for inpatients and outpatients - Identifies plans, coordinates, and implements high quality, cost-effective alternatives when appropriate to the patient’s condition - Supports physician decision making, working collaboratively with all members of the health care team, the patient, the patient’s family, co-workers, and internal and external customers to achieve optimal patient outcomes - Understands and effectively communicates requirements, and follows CCHP and Chinese Community Health Care Association policies and procedures - Accurately tracks as well as reports utilization and quality data Job Requirements: Excellent verbal and written communication skills. Able to communicate and collaborate effectively with physicians and allied health care providers Strong negotiation skills Ability to set and change priorities quickly and as the situation warrants Able to work independently and as a team player Working knowledge of Word and Excel Ability to maintain high volume workload without compromising quality. Expectation to manage a minimum of 20 patients at baseline Experience: Minimum two years acute inpatient care experienced required At least one year recent utilization management, discharge planning or case management experience preferred

jobs byAdzuna

Concurrent Review Nurse - Jackson

newabout 10 hours ago
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Job Description Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations - Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings - Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care - Conduct discharge planning Educate providers on utilization and medical management processes - Provide clinical knowledge and act as a clinical resource to non-clinical team staff - Enter and maintain pertinent clinical information in various medical management systems Requirements Licenses RN 2 years of relevant experience Job Type: Full-time Salary: $30.00 to $33.00 /hour

Concurrent Review Nurse - Portland

newabout 15 hours ago
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Hours: Monday - Friday; 8am - 5pm Pay: $40/hr Summary of position: - Complete computer based reviews of hospital stays - Send approval and denial letters - Handle discharge planning with Hospital staff - Work with administrative staff to assure smooth processing of authorizations - Work in large team to assure work is done daily Education/Experience: - Graduate from accredited School of Nursing - Bachelor's degree in Nursing preferred - 2 years of clinical nursing experience - Current state's RN license - High level of computer skills - Must be alright with no patient contact

RN Utilization Manager - Smyrna

newabout 17 hours ago
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Hours: Monday- Friday 8-5pm Job purpose : The Utilization management nurses role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays. Concurrent review of patient’s clinical information for efficiency Ongoing review of precertification requests for medical necessity Monitor the activities of clinical and non-clinical staff Coordinates patient’s discharge planning needs with the healthcare team Employ effective use of knowledge, critical thinking, and skills to: Advocate quality care and enhanced quality of life Prevent patient complications during hospital stay Advocate decreased hospital stay when appropriate Maintain accurate records of all patient related interactions Prepare monthly patient management and cost savings report Work in an intensive, fast-paced environment with minimal supervision Ability to stay organized and interact well with others in any situation Provide daily updates to Manager of Utilization Management for review Skills and Qualifications: • State licensure as a Registered Nurse (RN) • Minimum 2 years of prior experience in Utilization Management • Minimum 2 years of experience working with Managed Care Organizations

Health Plan Registered Nurse (RN) - Santa Barbara

new1 day ago
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We are in urgent need of a Health Plan RN for a well-known healthcare organization in the area. This is an entry level nurse position in managed care. If you are a nurse looking to get out of bedside nursing and more into the business side of nursing, this is for you!We offer competitive pay and benefits!Job Summary (General Overview, reporting to, work environment)The Health Plan Registered Nurse is an entry level nurse position. Depending on department assignment, this position reports to the manager of one of three clinical operational departments, Utilization Management, Case Management (Adult) or Pediatric Care Coordination and will provide assistance, including but not limited to; review of request for services, coordination of care and services for members, developing and maintaining care plans or care transition.Required:Excellent written, oral and interpersonal communication skillsStrong organizational and time management skillsGood computer literacy especially with Microsoft Office programsAs appropriate, understand adult or pediatric health conditions and disease processesAs appropriate, able to accurately interpret and apply clinical and regulatory guidelinesUnderstand HIPAA Privacy RuleAbility to work effectively in a cross-functional team environment in a collaborative way or independentlyAbility to quickly learn and use an electronic database, such as Essette, EPIC, HAX to document and summarize findingsPreferred:Knowledge of Medi-Cal and/or Medicare health care benefits, managed care regulations, including benefits and contract limitations, delivery and reimbursement systems, and role of medical management activitiesUnderstand basic utilization review principles and practicesUnderstand basic case management concepts and principles as described in the Case Management Society of AmericaJob Type: Full-time

Utilization Management Nurse

new1 day ago
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Hours: Monday - Friday; 8:30am-5pmPay: $45/hr Position summary: - Performs on-site, written or telephonic assessments and utilization review, across the continuum of care for inpatients and outpatients- Identifies plans, coordinates, and implements high quality, cost-effective alternatives when appropriate to the patient’s condition- Supports physician decision making, working collaboratively with all members of the health care team, the patient, the patient’s family, co-workers, and internal and external customers to achieve optimal patient outcomes- Understands and effectively communicates requirements, and follows CCHP and Chinese Community Health Care Association policies and procedures- Accurately tracks as well as reports utilization and quality dataJob Requirements:Excellent verbal and written communication skills. Able to communicate and collaborate effectively with physicians and allied health care providersStrong negotiation skillsAbility to set and change priorities quickly and as the situation warrantsAble to work independently and as a team playerWorking knowledge of Word and ExcelAbility to maintain high volume workload without compromising quality. Expectation to manage a minimum of 20 patients at baselineExperience:Minimum two years acute inpatient care experienced requiredAt least one year recent utilization management, discharge planning or case management experience preferred

Front Desk Coordinator/Administrative Associate

new1 day ago
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Enter TotalMed. We're an award-winning medical staffing agency delivering flexible healthcare staffing solutions no matter how complex your needs. But even more than that, we're a team who really ...

jobs byZipRecruiter

Utilization Management Nurse

new1 day ago
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We are in urgent need of a Utilization Management Nurse for a well-known healthcare organization in the area. We offer competitive pay and benefits!Job Summary (General Overview, reporting to, work environment)The UM Nurse performs prospective, concurrent, and retrospective reviews for long- term care, acute inpatient, specialty referrals, medical services and durable medical equipment. The purpose and goals of utilization management are to assure that CenCal Health members receive medically necessary care at the appropriate place, with the appropriate provider, and at the appropriate level of care.This position is responsible for timely review of request for services and based on established clinical guidelines and/or benefits limitations, determine appropriateness of requested services.Responsibilities include:Accurate interpretation of established clinical guidelinesPerform timely prospective review for services requiring prior authorizationPerform timely concurrent review for inpatient care in the acute care, subacute, skilled nursing, and long-term care settingPerform timely retrospective review for services that required prior authorization but was not obtained by the providerSupport and collaborate with the UM and CM Clinical Managers in the implementation and management of UM/CM activitiesActively participate in the development, implementation and the evaluation of department initiatives with the intent to assess any measurable improvements to member’s quality of carePerform selective claims review, and occasional onsite reviewAdhere to regulatory time frames for completion of reviewsKeep abreast of health care benefits and limitations, regulatory requirements, disease processes and treatment modalities, community standards of patient care, and professional nursing standards of practiceOther duties as assignedSkills/Knowledge/Abilities· Excellent written, oral and interpersonal communication skills· Good computer skills with accurate data entry into an electronic health record· Ability to analyze medical documentation and apply criteria to determine medical necessity, acuity of care, severity of illness and intensity of service· Ability to multi-task, organize and prioritize workload, and complete assignments in a timely manner· Knowledge of managed care issues, including benefits and contract limitations, delivery and reimbursement systems, and role of medical management activities· Work independently or cooperatively, as a team leader and member· Ability to organize work effectively in a cross-functional team environment in a collaborative way· Ability to communicate by phone and in person (in both individual and group situations) and to clearly and effectively communicate and negotiate with members and families, physicians and other health care providers· Maintain consistent and predictable attendance. Maintain sufficient level of punctuality and attendance to meet job standards and requirementsEducation and ExperienceRequired:· Current valid, unrestricted California Registered Nurse License· A minimum of one year experience as a Registered Nurse· Must be computer literate· Strong organizational skills and excellent verbal and written communication skillsDesired:· Prior utilization and/or case management experience in an inpatient, clinic, health plan and/or managed care setting· Certification in utilization review or healthcare management· Certified Case ManagerJob Type: Full-time

Concurrent Review Nurse RN

new1 day ago
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We are in urgent need of a Concurrent Review Nurse for a well-known health insurance company in TempeConcurrent review nurse Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinationsComplete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findingsCollaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member careConduct discharge planningEducate providers on utilization and medical management processesProvide clinical knowledge and act as a clinical resource to non-clinical team staffEnter and maintain pertinent clinical information in various medical management systemsDirect care to participating network providersParticipate in utilization management committees and work on special projects related to utilization management as neededPay: $36/hr

RN Utilization Manager - Smyrna

new1 day ago
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Hours: Monday- Friday 8-5pm Job purpose: The Utilization management nurses role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays. Concurrent review of patient’s clinical information for efficiencyOngoing review of precertification requests for medical necessityMonitor the activities of clinical and non-clinical staffCoordinates patient’s discharge planning needs with the healthcare teamEmploy effective use of knowledge, critical thinking, and skills to:Advocate quality care and enhanced quality of lifePrevent patient complications during hospital stayAdvocate decreased hospital stay when appropriateMaintain accurate records of all patient related interactionsPrepare monthly patient management and cost savings reportWork in an intensive, fast-paced environment with minimal supervisionAbility to stay organized and interact well with others in any situationProvide daily updates to Manager of Utilization Management for reviewSkills and Qualifications: • State licensure as a Registered Nurse (RN) • Minimum 2 years of prior experience in Utilization Management • Minimum 2 years of experience working with Managed Care Organizations

RN Field Care Manager - New Port Richey

new1 day ago
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Hours: 8am-5pm Monday-FridayLocation: Remote/Field basedJOB SUMMARY Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member. Coordinates, monitors and ensures that appropriate and timely primary, acute and long-term care services are provided to members across the continuum of care. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. Coordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works directly with the member in the field, i.e., inpatient bedside, member's home, provider's office, hospitals, etc. while collaborating with management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.

Licensed Practical Nurse - Appleton

new2 days ago
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Job: Licensed Practical Nurse Hours: M-F 8-5Pay: 30/hourLocation: Appleton, WI12 week contract Job Summary:The primary responsibility of this position is to assist patients within a clinical setting Preferred Education and licensing:Active LPN LicenseEPIC or EMR Expereince

Concurrent Review Nurse - Jackson

new2 days ago
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Job DescriptionPerform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations- Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings- Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care- Conduct discharge planning Educate providers on utilization and medical management processes- Provide clinical knowledge and act as a clinical resource to non-clinical team staff- Enter and maintain pertinent clinical information in various medical management systemsRequirementsLicenses RN2 years of relevant experienceJob Type: Full-timeSalary: $30.00 to $33.00 /hour

Case Management Nurse (RN)

new2 days ago
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We are in urgent need of Nurse Case Manager (RN) for a well-known healthcare organization in the area.This position is responsible for coordinating and managing specific CenCal Health members for defined periods of time and/or post discharge transition from an inpatient setting (e.g. acute care hospital, skilled or long-term care facility) to ensure that member’s outpatient care is being coordinated and that all medically necessary services are being provided in a timely manner. In addition, this position requires the management of complex care members over longer periods as deemed appropriate, as well as seniors and persons with disabilities, and potentially preventable admissions.Responsibilities include but are not limited to:Coordinate the provision of quality and cost-effective health care servicesCoordinate care and services for members and effectively and efficiently implement and complete the care management process. This process involves health screening, assessment, planning, coordination of care, and monitoring of member’s progress and complianceCollaborate with the member, the member’s family or caretaker, primary care provider, and other health care providersCoordinate timely care transition from one level of care to another, such acute to SNF or SNF to home or other living arrangement as the member’s care needs changeEffectively communicate and educate members about the health care delivery system and health plan benefits and limitationsIdentify care needs of the member, identify interventions, develop plan of care, implement necessary services, and establish timelines for case management servicesEffectively communicate verbally and in writing with primary care providers and other health care providers involved in the member’s careAdhere to Health Plan and department specific policies and proceduresRequired:Excellent written, oral and interpersonal communication skillsGood computer literacy and skillsStrong analytical and problem-solving skillsProficient multi-tasking and organization skillsUnderstand complex health care regulations such as HIPAA Privacy RuleAbility to adhere to and apply principles and professional standards of practice established by the Case Management Society of America (CMSA)Knowledge of Medi-Cal and/or Medicare Advantage plans, managed care regulations, including benefits and contract limitations, delivery and reimbursement systems, and role of medical management activitiesEducation and Experience· Current active, unrestricted California Registered Nurse License with a minimum two (2) years’ experience as a Registered Nurse· Valid California Driver’s License with a clean driving record needed· Proficient with computer and Microsoft Office, Word, Excel, PowerPoint· Strong organizational skills and excellent verbal and written communication skills· Desired:· Certification in case management, utilization review, or healthcare management· Prior UM/CM experience in a managed care settingJob Type: Full-timeSalary: $70,000.00 to $108,000.00 /year

Medical Biller

new2 days ago
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Enter TotalMed. We're an award-winning medical staffing agency delivering flexible healthcare staffing solutions no matter how complex your needs. But even more than that, we're a team who really ...

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Concurrent Review Nurse - Portland

new2 days ago
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Hours: Monday - Friday; 8am - 5pm Pay: $40/hr Summary of position: - Complete computer based reviews of hospital stays- Send approval and denial letters- Handle discharge planning with Hospital staff- Work with administrative staff to assure smooth processing of authorizations- Work in large team to assure work is done daily Education/Experience: - Graduate from accredited School of Nursing- Bachelor's degree in Nursing preferred- 2 years of clinical nursing experience- Current state's RN license- High level of computer skills- Must be alright with no patient contact

RN Case Manager - Smyrna

new2 days ago
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Hours: Monday-Friday 8:00-5:00pm Pay rate: $32-$40/hr Job Description: Responsible for health care management and coordination of members in order to achieve optimal clinical, financial and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitors member’s progress and services to ensure consistent cost effective care that complies with policy and all state and federal regulations and guidelines. • Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for members. • Conducts face to face or home visits as required. • Maintains department productivity and quality measures. • Manages and completes assigned work plan objectives and projects in a timely manner. • Develop, assess and adjust, as necessary, the care plan and promote desired outcome • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options • Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients • Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs • Provide patient and provider education • Facilitate member access to community based services • Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan • Actively participate in integrated team care management rounds • Identify related risk management quality concerns and report these scenarios to the appropriate resources • Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems Required experience: • RN License • Familiarity with NCQA standards, state/federal regulations and measurement techniques. • In depth knowledge of CCA and/or other Case Management tools

Nurse Case Manager

new2 days ago
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Looking For Previous CM or UM experienceAcute care experience – med surg, ED, ICEHome health or hospice experienceStrong computer skills Description Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinationsComplete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findingsCollaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member careConduct discharge planningEducate providers on utilization and medical management processesProvide clinical knowledge and act as a clinical resource to non-clinical team staffEnter and maintain pertinent clinical information in various medical management systemsDirect care to participating network providersParticipate in utilization management committees and work on special projects related to utilization management as neededFor New Hampshire and Massachusetts - home visits requiredQualifications Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2 years of clinical nursing experience and 1 years of utilization management experience in a managed care setting. Acute care experience preferred. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs

Utilization Management Nurse

new3 days ago
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We are in urgent need of a Utilization Management Nurse for a well-known healthcare organization in the area. We offer competitive pay and benefits! Job Summary (General Overview, reporting to, work ...

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Pharmacy Technician II

about 1 month ago
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TotalMed Staffing, Inc. provides temporary, contract, and full time staffing services to hospitals and hospital systems, medical groups, and solo practitioners who require staffing assistance in ...

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Recruiter

5 months ago
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TotalMed Staffing is actively seeking energetic, charismatic, and intelligent individuals to join our team of travel nurse recruiters! While experience is not required, the desire to work hard and ...

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Healthcare Recruiter

7 months ago
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Healthcare Recruiter TotalMed is looking for an individual who is goal oriented, self-motivated, and interested in working in a competitive environment that has a work hard, play hard mentality. The ...

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