Overview Oversees the completion and approval of all clinical utilization documentation, including Start of Care, Re... visit utilization using evidence-based practices to provide positive clinical outcomes and efficient use of resources...
services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical... review of all components related to requests for services which includes a clinical record review and interviews with members...
Overview Leads the clinical audit team and oversees quality improvement initiatives with a primary focus on Medicare... STARS and clinical program performance for VNS Health Plan. Ensures regulatory compliance with CMS and DOH standards...
’s condition, emergency intervention, or care plan changes. Reports all interventions made to the clinical manager and documents... Health Aides (HHA). Provides case management support, clinical intervention, development of care plan and follow up...