…knowledge base of health care delivery and case management within a managed care environment. + Comprehensive knowledge of Utilization Review, levels of

…the Commission for Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (CMCN) desired. We're ChenMed and we're transforming

…Basic Life Support Certified/certification eligible in relevant specialty such as: + Certified Managed Care Nurse through the American Board of Managed

…with patients, families, providers, other caregivers and disciplines to create a structure of managed care for complex patients. Quality Care Managers help

…date on hospital clinical quality, benchmarking, and best practices + Well versed in managed care and health policy . Ability to work effectively with hospital

… care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral

…information utilizing internal and electronic sources. 23. Obtains and documents managed care referrals, required pre-certifications and authorizations as

…experience in inpatient case management, social work or utilization management or in the managed care /payer environment, of which one year must have been in a

…abreast of regulatory processes and payer systems such as Medicare, Medicaid, managed care , and private sources, as applicable. Demonstrate extensive advanced

…long and short-range changes in the reimbursement environment including Medicare, Medicaid, Managed Care , and Commercial medical and pharmacy plans while