This position is 100% remote, working from home. The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are…
Experience Details: Combined experience in utilization management, case management, home health and clinical. Experience with Diamond, Jiva or InterQual.
Graduate of an ACEN (Accreditation Commission for Education in Nursing), CCNE (Commission on Collegiate Nursing Education), NLN (National League for Nursing) or…
Bachelor of Science in nursing in a related health field. Maintain medical records in accordance with department or company policy and/or any applicable federal…
Recommends changes to management or health care delivery procedures. Advanced degree in nursing or related healthcare field is preferred.
EDUCATION: High School Diploma or equivalent, supplemented by college courses or an accredited training program in business or office administration or related…
The purpose of this position is to ensure that Archcare Community Life MLTC members obtain timely, cost-effective, quality care in the appropriate setting.
No supervisory or management authority. Provides data management support for refugee housing, legal, health services. A bachelor’s degree is preferred.
Provides educational resources and/or referrals to patients/families to address identified needs such as social or financial needs.
Reviews cost, quality, safety, utilization, and value data regularly with nursing leaders, clinical leaders, and health system executives; responsible for both…
Makes appropriate decisions and interventions and nursing diagnosis according to patients actual or potential health conditions or needs.
Graduate of an accredited school of nursing. This role is remote and work from home, with occasional travel required. Valid Driver’s License in good standing.
