2 clinical manager registered nurse jobs found

Job Summary :  Identifies and facilitates appropriate non-acute Health Services for high-risk utilizers of Emergency Department Services. The Registered Nurse or Social Worker will address social determinants that may lead to subsequent hospitalization. Provides psychosocial assessments, plans, and implements various counseling, conducts, and coordinates discharge planning for consulted patients in the Emergency Department or as needed. Will also act as a resource to the Emergency Department staff to help with discharge planning and offer resources to patients and families as needed.  These include Primary Care, Home Health, Palliative, Hospice, Assisted Living facilities, Skilled Nursing facilities and other post-acute community services. Identifies recent patients discharged from the hospital and initiates clarification of the reason/cause for Emergency Department visits.  Focuses on the reduction of 30-day re-admissions. Utilizes multidisciplinary conferences as appropriate....

The UM Clinical Specialist-Behavioral Health performs professional and administrative work, primarily utilization reviews, utilization management and active care management to ensure economical and effective consumer service delivery by PHIP enrolled network providers; The position is responsible for providing medical necessity reviews of individualized service plans and requests for authorization of services to ensure consumers receive services in the least restrictive, most integrated setting appropriate to the individual’s needs; The primary role is to review for services under the Medicaid B waiver and state funded benefits; complete related work as required. This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed. Responsibilities & Duties Utilization...