- Alameda Health System (San Leandro, CA)
- … concurrent reviews assigning acute, administrative and denied days as per ACBH concurrent review policy. 23. Utilizes clinical knowledge and defined ... Clinical Nurse III, Acute Inpatient Behavioral...identified fields in EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the CMHS. ... Apply qualitative and quantitative analytical techniques, such as prospective, concurrent , and retrospective reviews. Determine the effectiveness of healthcare… more
- Katmai (Fort Carson, CO)
- …medical necessity, referring to the Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part ... UMRN program, conduct ongoing availability, monitoring and oversight of non- clinical staff activities. + Establish effective rapport with other...licensed in Colorado, be able to practice using a nurse compact state license or have a license from… more
- Stanford Health Care (Palo Alto, CA)
- …risk stratification of at-risk patient populations, acute and skilled nursing facility concurrent review and complex and episodic case management, including the ... member homes, provider offices or facility settings. S/he will conduct concurrent review and issue appropriate member/provider correspondence. **Locations**… more
- Stanford Health Care (Palo Alto, CA)
- …improvement activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection; ... payers to assure reimbursement for patient services/procedures. Communicates with review organizations/payers to provide requested clinical and psychosocial… more
- Stanford Health Care (Palo Alto, CA)
- …improvement activities by identifying opportunities forimprovement in such areas as clinical outcomes, utilization of resources and concurrent data ... clinical and psychosocial information to assurereimbursement. + Utilization Review -- Reviews prospectively, concurrently and retrospectively all inpatients… more
- Centene Corporation (Springfield, IL)
- …InterQual knowledge, and discharge planning knowledge. **Additional Details:** Department: Concurrent Review MCD** Business Unit: Corporate** Schedule: Mon-Fri ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Vitalief (Philadelphia, PA)
- …role will support the planning, implementation, and execution of multiple concurrent clinical research studies, including NIH-sponsored, industry-sponsored, and ... operate more efficiently and grow sustainably. The Role We are seeking an experienced Clinical Research Nurse to join our exceptional team as a full-time… more
- Geisinger (Danville, PA)
- …provided. The core of the program uses highly trained staff members to perform a concurrent inpatient review of the record. This allows the record to be coded ... work on site position located in Danville, Pennsylvania. The Clinical Documentation Improvement Program (CDI) is designed to improve...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- Blue KC (Workman, MN)
- …authorization letters, and follows in FACETS UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside medical ... case management and clinical transplant experience + Valid and active Registered nurse (RN) licensure in all 50 states and the District of Columbia initiated… more
- Geisinger (Danville, PA)
- …provided. The core of the program uses highly trained staff members to perform a concurrent inpatient review of the record. This allows the record to be coded ... Job Summary The Clinical Documentation Improvement Program (CDI) is designed to...Dayshift; Monday through Friday. Candidates must hold a Registered Nurse license in Pennsylvania or a Multistate License. A… more
- Ansible Government Solutions (Memphis, TN)
- …success as if it is their own. Responsibilities + Act as the Registered Nurse Advisor for the facility's CDI program, focusing on both inpatient and outpatient ... services + Review health records concurrently to identify opportunities for improved...identify opportunities for improved documentation and coding accuracy using clinical knowledge and critical thinking skills + Support CDI… more
- Houston Methodist (Houston, TX)
- … functions through point of entry, observation progression of care management, concurrent review and denials reviews. Additionally, the URSN will prospectively ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is...regarding any claim issues or concern that may require clinical review during the pre-bill, audit, or… more
- UNC Health Care (Kinston, NC)
- …+ Minimum 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience ... clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria… more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality/Utilization Review Nurse Position Summary: The Quality/Utilization Review Nurse is responsible for evaluating the medical necessity, ... infection prevention protocols and regulatory compliance. Key Responsibilities: * Utilization Review : o Conduct concurrent and retrospective reviews of patient… more
- CDPHP (Latham, NY)
- …The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes ... exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care… more
- Catholic Health (Kenmore, NY)
- … to patients and families in the hospital setting. Utilizing foundational nursing clinical skills Utilization Review nurse collaborates with the ... Rotation Hours: 8 am- 4 pm Summary: The Registered Nurse (RN), Utilization Review , as an active... Activities. This includes, but is not limited to, concurrent review , responding to inquiries, complaints, and… more
- University of Utah Health (Salt Lake City, UT)
- …and continued stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient ... expected cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- UNC Health Care (Kinston, NC)
- …assures timely movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of ... the right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care,… more
- Beth Israel Lahey Health (Cambridge, MA)
- …reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret data, and implement ... + Reviews medical records to collect data for reporting quality measures, including both concurrent medical record review and periodic medical record review … more
