- Centene Corporation (Sacramento, CA)
- …position that requires a CA RN Licensure.** **Position Purpose** : Performs concurrent reviews, including determining member's overall health, reviewing the type of ... time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's… more
- Trinity Health (Fresno, CA)
- …maintaining current knowledge of clinical indicators and compliance requirements, conducting concurrent medical record review to ensure documentation compliance ... required. Bachelor's degree in Nursing, Health Science, or related field is preferred. 2. Current licensure as a Registered... is preferred. 2. Current licensure as a Registered Nurse in the State of California is required. 3.… more
- Centene Corporation (Sacramento, CA)
- …providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically appropriate determinations + ... California RN Licensure. **Position Purpose:** Performs a clinical retrospective review of services previously provided to determine if the...and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- …all dimension requirements for Nurse III; OR a Master's degree in *related field with BSN and two years of specialized nursing experience, one of which is ... Summary The Emergency Department Utilization Management (ED-UM) Registered Nurse (RN) is responsible for providing competent, evidence-based practices within the… more
- Sacramento County (Sacramento, CA)
- Nurse Practitioner Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1780920) Apply Nurse Practitioner Salary $127,576.80 - $155,096.64 ... on: 9/27/2024, 10/25/2024, 11/22/2024, 12/27/2024, 1/31/2024, 2/28/2024, 3/28/2024, 4/25/2024 Nurse Practitioners provide a range of health care services involving… more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse D/CF Salary ... are at 5:00 pm on: 6/3/24, 8/5/24, 10/7/24, 12/2/24 Supervising Registered Nurse - Detention/Correctional Facility is the first level supervisory class in this… more
- Sacramento County (Sacramento, CA)
- Supervising Public Health Nurse Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/600083) Apply Supervising Public Health Nurse Salary ... the operations, program, and personnel of a public health field office staffed by professional nurses, health workers and...One year of experience as a Senior Public Health Nurse in Sacramento County service. Or: Two years of… more
- G-TECH Services, Inc. (Detroit, MI)
- . Engagement Description - Perform prospective, concurrent and retrospective review of inpatient services to ensure medical necessity, appropriate length of ... initiated by providers, facilities and members. Responsible for the review of precertification, admissions approvals, telephone triage, and/or benefit… more
- ChenMed (Warren, MI)
- …departments, external service organizations, agencies and healthcare facilities. + Conducts concurrent medical record review using specific indicators and ... through the integrating and functions of case management, utilization review and discharge planning. The incumbent in this role...with bachelor's degree in home in a related clinical field preferred. + A valid, active Registered Nurse… more
- HCA Healthcare (Houston, TX)
- …for reviewing, monitoring and reporting hospital utilization of resources through concurrent review according to pre-established guidelines and criteria and ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...evaluator. Actively participates in the collaborative program which requires review of patient activities related to medical necessity of… more
- Northwell Health (Huntington, NY)
- …to another level of care according to regulatory standards. + * Performs concurrent utilization management using Interqual criteria. + Conducts chart review for ... Sheet and the Patient Transfer Sheet. + Ensures Patient Review Instrument (PRI) is completed and reflects clinical profile...+ Current license to practice as a Registered Professional Nurse in New York State. + Case Management Certification,… more
- BrightSpring Health Services (Martinsburg, WV)
- …Registered Professional Nurse + Excellent communicator with ability to handle concurrent tasks and responsibilities + Ability to travel within assigned area + ... meetings + Chairing committees as appropriate, safety, infection control, incident review , and human rights committees + Facilitating communication and serving as… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …the clinical treatment team to insure optimal reimbursement for services provided. + Review concurrent denials from third party payers with the interdisciplinary ... discharge planners regarding transition to alternative levels of care. + Perform concurrent utilization review applying identified criteria at prescribed … more
- Centene Corporation (Raleigh, NC)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …RN is responsible and accountable for receiving, processing and documenting all concurrent denials for assigned facilities. The RN has an integral role within ... management process. The Denials RN performs a root cause analysis of the concurrent denial, formulates and implements a plan for addressing the specific root cause… more
- Tufts Medicine (Burlington, MA)
- …and regulatory compliance related to the CDI and coding functions. 2. Performs initial concurrent review of new patients every day and concurrent re-reviews ... The role of the Clinical Documentation Integrity (CDI) Specialist III is responsible for concurrent and retrospect review and analysis of the medical record to… more
- Sharp HealthCare (San Diego, CA)
- …requests to ensure medical necessity and payer considerations are reviewed.Perform initial and concurrent review on intent to bed or bedded patients. Works ... **Shift End Time** Bachelor's Degree; Associate's Degree in Nursing; California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM)… more
- Sharp HealthCare (San Diego, CA)
- …Represent management (as requested) at system and site level meetings.Perform initial and concurrent review on intent to bed or bedded patients. Works ... Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM)… more
- Nuvance Health (Danbury, CT)
- …level of care. Develop clinical criteria and guidelines for efficient UR processes. * * Concurrent Review :* Oversee the concurrent review process, ... leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff...field preferred * Current licensure as a registered nurse (RN) * Minimum of 5 years of clinical… more
- WellSpan Health (York, PA)
- …performance (on-site liaisons and telephonic liaison staff) and the function of precert, concurrent review and denial management. + Acts as a resource to ... conducts initial reviews to ensure medial appropriateness of setting, concurrent review to ensure medical necessity for...professional affiliations to keep abreast of latest trends in field of expertise. + Provides outstanding service to all… more