Springfield Place is a beautiful senior housing community managed by Leisure Care , a leader in the senior living industry for over 40 years! We are seeking an

…the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers,

…new path? Start doing your life's best work.(sm)Optum/USMD Senior Oncology Infusion Nurse Oversees daily clinical operation, to include RN and MA supervision, while

…impacting development, interpretation, and implementation of medical policy or other managed care initiatives.QualificationsNurse Appeals* Requires 2 years of

…Experience in MDS - required MDS experience with Public Aid, Medicare A and Managed Care assessments and reimbursement including care planning Familiarity

…an understanding of MDS requirements related to varied payers including Medicare, Managed Care and Medicaid.Ensures timely electronic submission of all Minimum

…HEDIS, Healthcare Effectiveness Data and Information Set, Utilization Management, Utilization Review, Managed Care , Care Manager, Queue Management, Case

…years of progressively responsible healthcare experience to include experience in a managed care setting, and/or hospital settings, and/or physician practice

…managing key relationships with hospital therapists, physicians, key hospital staff, managed care providers, rehab suppliers, and other key referral

…an understanding of MDS requirements related to varied payers including Medicare, Managed Care and Medicaid Facilitates the Care Management