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Um Denial Coordinator Lvn Jobs

Service Coordinator - Lvn
By Superior HealthPlan At , Mcallen
Provide education related to member’s health condition and care
Coordinate member care through collaboration with community outreach and member advocates, assigned service coordinators, and/or case managers
Conduct in-home face to face member assessments and telephonic outreach
Document assessments and contacts, develop and approve service plans, and ensure authorizations are completed
Conduct follow-up contacts or in-person visits to determine if services meet member’s needs
Assess member’s medical, safety and support service needs and coordinate the delivery of services
Legal Assistant Bi/Um (Hybrid)
By USAA At , Seattle, 98101
Intermediate knowledge of the function/discipline and demonstrated application of knowledge, skills and abilities towards work products required.
Oversees management and maintenance of attorneys' files per the attorney's specifications.
Identifies and manages existing and emerging risks that stem from business activities and the job role.
Collaborates with team to evaluate risk of alternatives and calculate costs of potential liability and assesses benefits/drawbacks.
Applies intermediate knowledge to assist with proper filing of documents with regulatory authorities, courts, other tribunals, monitors status and distributes copies.
1 year of experience in legal support or related experience to include multi-tasking in a fast paced and complex business environment.
Um Administration Coordinator (Central Region)
By Humana At ,
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
1 or more years of administrative, telephonic customer service and/or healthcare experience
Excellent verbal and written communication skills
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Proficient and/or experience with medical terminology and/or ICD-10 codes
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job
Lvn Care Coordinator - Longview, Tx - Remote
By UnitedHealthcare At , Longview, 75602, Tx
Manage the care plan throughout the continuum of care as a single point of contact
2+ years of clinical experience in a health care role
Experience with arranging community resources
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services
Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
Denial Management Specialist Jobs
By Expeditive, LLC At United States

Denial Management Specialist must have at least 5 years of relevant work experience. Must have Cerner EMR experience. Remote but must keep PST schedule, Monday thru Friday full time. Ideal ...

Data Entry Tech (Um)
By Impresiv Health At Orange, CA, United States

The Data Entry Tech will be responsible to perform routine to complex data entry. The incumbent will provide office support functions as needed for the Utilization Management department. Candidates ...

Um/Br Coordinator, Case Management
By Imagine360 At United States
1+ years in Case Management or transferrable nursing experience and skills.
Experience working in a URAC accredited Case Management program preferred.
Identify, collect, process, and manage data to complete reviews for medical necessity per Medical Management approved clinical guidelines.
Employ effective use of knowledge, critical thinking, and skills to:
Staff complex cases with Team Lead and/or Supervisor, Case Management.
Consult with Medical Management Physician Advisor or peer reviewer per policy and procedures.
Um Intake Coordinator Jobs
By Evolent Health At United States
Maintains a current knowledge base with regards to rules, regulations, policies, and procedures relating to precertification and concurrent review.
Customer service skills including call center experience required.
Continue to prioritize the employee experience and achieved a 90% overall engagement score on our employee survey in May 2022.
Provides provider with case reference number upon completion of data entry and /or clinician approval.
Excellent written and verbal communication skills.
Proficient experience using Outlook, Word, Excel and PowerPoint in a Windows operating system.
Clinical Supervisor - Um - Gov Programs
By CareCentrix At , Remote $60,000 - $72,000 a year
You are competent and experienced with Utilization Management and Regulatory and Accrediting agency standards.
You should get in touch if: (Required education, skills and experience)
Serve as a resource for the Utilization Management program and clinical guideline applications
Support operations and management team with clinical feedback and utilization training
Partner with Operations Leadership, Clinical Management, and the Quality Department to support clinical and utilization management goals and objectives.
Track and monitor turnaround times to assure service requirements are met
Care Coordinator Lvn Jobs
By Baylor Scott & White Health At , Remote $21.12 an hour
Assists patients with self-management through education, visits and telephonic engagement; encourages and helps patient adherence to their care plans.
Basic knowledge of care management and resource and utilization management.
Coordinates patient care management plans, interventions, treatment goals, and self-management goals.
Assesses the health care, educational, psychosocial needs of the patient and family.
Immediate eligibility for health and welfare benefits
Our competitive benefits package includes the following
Um Nurse Consultant Jobs
By CVS Health At , , Fl $28.25 - $60.50 an hour
Minimum 2 years of clinical experience
Position requires proficiency with computer skills which includes navigating multiple systems
Complete at least 10 NF member assessments weekly
Rebalance a minimum of 5 members a month or clearly document why goal was not met.
Support the Health Plan Rebalancing Initiative goal of successful transitions: Assess, identify, screen and transition NH members into the community
Drive enhanced value of health care to increase member satisfaction and retention, and drive new membership growth.
Um Rn Jobs
By Centers Plan for Healthy Living At Jamaica, NY, United States
Minimum 2 years utilization management experience
Utilizes knowledge of community resources and the member’s benefit structure
Experience working within a managed care environment
Have a knowledge of the Appeals and Grievances process
Strong written and verbal communication skills
Knowledge of Milliman or InterQual criteria
Care Coordinator (Lvn/Cma)
By Wellness Pointe At , Longview, 75601, Tx
Participate in team decisions regarding data requirements for pro-actively managing the team’s panel.
Two (2) years experience in a heathcare arena or Six (6) + years experience in lieu of degree will be considered
Preferred general or community health nursing experience.
Interacts with involved departments to negotiate and expedite scheduling and completion of tests, procedures, and consults.
Executes internal and external referrals to assure timely care for patients.
Follows-up with patients after an emergency room visit or hospital discharge.
Um Administration Coordinator (Remote - Weekends)
By Humana At , Louisville, 40202, Ky
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
1 plus years of administrative, customer service or healthcare experience
Excellent verbal and written communication skills
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Proficient and/or experience with medical terminology and/or ICD-10 codes
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job
Um Service Coordinator Jobs
By Fallon Health At Worcester, MA, United States
Initiates entry of request(s) into core system (QNXT/TruCare) and case management application (TruCare) as applicable.
Manage applicable queues in both the core system (QNXT UM and Call Tracking) and the case management application (TruCare).
Mature judgment: knows when to seek guidance/direction and or when to refer problems to management
Manage the Call Tracking module in the core system (QNXT) as required.
Some advanced education highly preferred.
Excellent telephone, typing and computer skills
Um Administration Coordinator- (Northeast Region)
By Humana At , Lancaster, 29720, Sc
Must meet Humana's Work at Home policy listed in additional information
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
1 or more years’ experience working in an administrative support capacity in the healthcare industry
Prior experience in a metric driven environment
Proficient and/or experience with medical terminology and/or ICD-10 codes
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Um Rn Jobs
By Centers Plan for Healthy Living At Staten Island, NY, United States
Minimum 2 years utilization management experience
Utilizes knowledge of community resources and the member’s benefit structure
Experience working within a managed care environment
Have a knowledge of the Appeals and Grievances process
Strong written and verbal communication skills
Knowledge of Milliman or InterQual criteria
Um Coordinator Jobs
By Centers Plan for Healthy Living At Margate, FL, United States
Experience working within a managed care environment
Participates in case round meetings and on-going education activities
Ensures that all job responsibilities are carried out in compliance with CPHL and State and Federal regulations
Strong written and verbal communication skills
Assists in the prior authorization of services and ongoing authorization requests
Assists in completing authorization updates as needed based on the care plan of the member
Um Care Coordinator Jobs
By Centers Plan for Healthy Living At Jamaica, NY, United States
Experience working within a managed care environment
Participates in case round meetings and on-going education activities
Ensures that all job responsibilities are carried out in compliance with CPHL and State and Federal regulations
Strong written and verbal communication skills
Assists in the prior authorization of services and ongoing authorization requests
Assists in completing authorization updates as needed based on the care plan of the member
Um Denial Coordinator Lvn
By Texas Children's Hospital At , Houston, 77001, Tx
Required 5 years of Utilization Management experience and a preferred 3 years of Denial or Appeal experience
Analyzes requests against regulatory and decision-making guidelines and benefits allowance.
Provides community education for other reviewers on guideline application, changes, and updates
Educates physician reviewers and nursing staff on policies and procedures of the Texas Children's Health Plan managed care and Medicaid
Graduation from an accredited School of Vocational Nursing
LVN - Lic-Licensed Vocational Nurses by the State of Texas