Managed Care Resources MCR Jobs in Hollywood

7 jobs

Job Description: The Nurse Practitioner works in collaboration with a multidisciplinary team to provide a complete range of clinical care. Instrumental in educating patients and their families in order to prevent health problems and promote overall wellness. Perks: Opportunity to work for an established and successful organization Competitive pay and benefits Work with patients from all age ...

Telephonic Triage Nurse - Registered Nurse Assesses and Triages patients Maintains clinical competency, as demonstrated in providing and directing patient care Participates in the case management of individual patients to ensure the continuity of care. Produces required reports on a timely basis. Exercises appropriate judgment and good decision-making skills Keywords: Case Manager Impatient...

Registered Nurse for a Managed Care Company Apply case management concepts, principles, and strategies to develop a Plan of Care (Care Plan) that addresses the member’s needs and limits patient hospitalization Telephonic assessments ensuring members receive all necessary care allowed under their benefit plan. Review of medical records and/or other documentation to determine medical necessity, a...

Ambulatory Case Manager – Managed Care - 40 hours per week 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 address...

Registered Nurse Quality Improvement Specialist (QI, QA) Major Home Health, Hospice Department Improvement Specialist with 3 + Years Experience in Quality Hospice/ Home Health / Long Term Care Setting Detailed orientated, excellent computer skills, knowledge of excel data bases Excellent verbal and written communication skills. Familiarity with Medicare, Title 22 and Joint Commission regulati...

Claims Supervisor Oversee the claims examiner team while monitoring daily workflows. Contributes to daily production standards and output. Reviews daily operational reports as needed throughout the day to assure compliance. Maintains controls to insure that claims are processed within regulatory requirements. Responsible for staff orientation and training. Requirements 2-4 years experience ...

Revenue Recovery Analyst - Medical Claims Department Looking for a professional with a background in Claims Processing using EZ-Cap software Skilled with Excel and data entry skills Knowledge of Refund Posting, Eligibility Retro Audits, ER Duplicate Claims Maintains a solid working knowledge of Healthplan and provider contracts, division of responsibility (DOFR), and CPT/ICD9 coding. Monday-F...