Managed Care Resources MCR Jobs in Corona

Currently, there are no Managed Care Resources MCR jobs available in Corona, California. You may wish to explore jobs in nearby locations on the Managed Care Resources MCR jobs in California page or view related jobs below.
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Ambulatory Case Manager – Office Setting Duties: Responsible for the care management (coordination of outpatient care) of members with catastrophic illnesses and the chronically ill while ensuring that quality standards are met by using clinical judgment to evaluate and assess. Apply case management concepts, principles, and strategies to develop a Plan of Care (Care Plan) that addresses the me...
Case Manager, Inpatient (Concurrent Review) Monday - Friday; 8/hr/day About the Job: Utilization Review, Concurrent Review, Discharge Planning, Transfers Level of Care and length of stay reviews (SI / IS) Reviews, verifies and processes requests for referrals, inpatient and outpatient procedures, home health services, DME Strong problem solving and organizational skills Knowledgeable of: D...
Nurse Case Manager (Registered Nurse) Mon.-Fri. 40 hours per week Duties: Responsible for the care management (coordination of outpatient care) of members with catastrophic illnesses and the chronically ill while ensuring that quality standards are met by using clinical judgment to evaluate and assess. Apply case management concepts, principles, and strategies to develop a Plan of Care (Care ...
Nurse Case/Care Manager - Telephonic, Desk Job About the Job: · Care Coordination · Reviews, verifies and processes requests for referrals/authorizations of services. · Strong problem solving and organizational skills in a fast paced environment. · Coordination of care and quality of care. Knowledgeable of: · Effective charting practices and guidelines. · Principles and practices of health...
This is a position that focuses on utilization review including assessment of medical records for appropriateness, level of care provided. You will assess utilization of treatment, modalities, medications, services and application of treatment protocols. A team approach with other members of internal staff is important. Requirements: California Nurses license, Registered Nurse (RN) Utilization ...
Ensuring the quality of credentialing files of contracted providers in accordance with NCQA and DHS guidelines. Responsible for maintaining internal quality standards, supporting the Credentialing Committee program and coordinating Health plan activities. About the Job: Processes credentialing/re-credentialing files for committee review (NCQA/state regulatory requirements) Ensures that provide...
Review referral requests (routine, urgent & stat) for various office visits, outpatient and inpatient procedures using Milliman Care Guidelines to determine medical necessity Coordinate reviews, deferrals & denials with medical director, medical groups, health plans Create denial letters based on the MD's review and guidelines Submit treatment authorization requests to health plans as needed D...
Description We are looking for a successful Medical Biller to work at a small Mental Health hospital in the Van Nuys area. This is a full time position offering a competitive salary and full benefits. Candidates with a proven track record in a hospital setting doing coding, billing, and collections need only apply. Description of Responsibilities: Health Plan follow-up for claim status Read ...
Case Manager Registered Nurse (RN) Full Time, 40 Hours Per Week About the Job: Concurrent review and analysis of inpatient records to determine if the patient's admission and continued hospital stay triggers any pre-defined quality indicators. Utilization review including assessment of medical records for appropriateness, level of care provided. Assess utilization of treatment, modalities, m...

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