The Utilization Management Specialist is responsible for executing the UM function, which includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients. Oversees the response to requests for services and interfaces with managed care organizations, external reviewers, and other payers. Assures that good customer service practices are utilized. Maintains denials and appeals in Midas and reviews the progress of all appeal activity.
QualificationsEducation: Diploma required. Associate or Bachelor Degree in Nursing or Social Work preferred.
Experience: Two (2) years direct clinical experience in a psychiatric or mental health treatment setting preferred. Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.
Licensure: Valid Indiana Registered Nursing or LCSW preferred
Hours of Work: May be required to work overtime and flexible hours.
...Project Overview: Support CBPs Trade Policy and Programs Directorate with research, policy... ...Description: The Business Process Analyst will be part of a team conducting... ...Excellent communication skills across all levels of business, both written and verbal~...
...and communicates expectations and standards to associates; monitors performance and provides effective feedback and coaching. Coordinates resources to obtain recommended treatment. Develops, cultivates, and maintains internal and external relationships within the...
...We are a Wisconsin based trucking company with headquarters in Oshkosh, WI and locations... ...a full-time opening on our team for a Class A Floater Driver in the Oshkosh, WI areato fill in... ...customer accounts - this position is home daily!~ Home Daily ~ Monday-Friday, off...
...documents patient interviews to obtain demographic and financial data for registration, insurance verification, precertification and... ...priorities in an effective and organized manner.Excellent data entry, numeric, typing and computer navigational skills.Basic computer...
...applications. Correct problems and prevent security breaches. Design security elements... ...security resources for new and emerging cyber threats Establish security... ...three years working as a Cyber Security Engineer Three years working experience threat...