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RN Case Management with Quality Management Experience
Care1st - San Diego, California
Healthcare / Nursing
Job Description General Summary:   The QI HEDIS Network Support Nurse will provide clinical support to the Network Support team responsible for outreach, training, development and engagement of MSO, PPG/IPA and Providers. The HEDIS Network Support Nurse is responsible for performing medical record review and audit, data extraction, maintaining the HEDIS data and computer systems The Nurse will supervise and oversee Network Support Coordinators and assist the Clinical Supervisor and HEDIS Manager in the maintenance and update of Web Portal content. This position will require … (see more)
Utilization Management Nurse-Case Management
CHOP - Philadelphia, Pennsylvania
Healthcare / Nursing
Req ID:10614 Shift: Days Employment Status:AF - Active - Regular - Full Time Job Summary Under the general supervision of the Sr. Director, Case Management the Utilization Management Nurse provides comprehensive assessment, coordination, implementation and reporting of complex clinical data. The Utilization Management Nurse assesses the patient’s plan of care and progress of the patient throughout an acute care admission. The intensity of assessment is situational and appropriate based on payer requirements. This position is accountable for the communication of the clinical … (see more)
Director, Medical Management (Case Management)
Centene Corporation - Sacramento, California
Healthcare / Nursing
Description: Position Purpose: Creates clinical programs to meet the needs of members in Care Management. Works closely with Medical Informatics team to identify trends that need to be addressed with program management. Monitors the program work plan to assure attainment of Medical Management annual goals. Responsible for Care Management clinical inter-rater reliability and monitoring important aspects of care. Directs the work of subordinates in dissimilar functions. Effectively manages the activities of staff providing leadership and guidance. Interviews, recommends for hire, and … (see more)
Lead / Utilization Management / Care Coordinator - Case Mana
Adventist Health Southern California - California
Healthcare / Nursing
Job Summary: The Lead / Utilization Management / Care Coordinator is responsible for the direct oversight of the case management daily operation. This individual reports directly to Case Management Director. The Lead / Utilization Management / Care Coordinator will oversee the utilization management functions, ensuring all functions associated within the department are following all necessary department/facility practices in collaboration with the interdisciplinary team. The goal of this position is to ensure that the appropriate level/intensity of care is provided in a cost-effective manner … (see more)
RN, Registered Nurse Case Manager - Case Management
Christus Health - South/Corpus Christi, Texas
Healthcare / Nursing
DescriptionRN Case Manager will work with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care.RequirementsGraduate of an accredited school of nursing.Minimum of 3 years of clinical experience required. Case … (see more)

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