- Actalent (Kansas City, KS)
- Hiring for Utilization Review Nurse Job Description As a Utilization Review Nurse , you will ensure the quality and continuity of care for our members by ... discuss and improve member care. + Document and maintain concurrent review findings, discharge plans, and actions...to improve care levels and medical necessity based on clinical policies. + Review members' transfer or… more
- FlexStaff (Uniondale, NY)
- **Req Number** 149644 FlexStaff is seeking a Temporary Clinical Review Nurse for our client, a non-profit healthcare organization providing home and ... Director of Clinical Review , the Clinical Review Nurse is responsible...-Collects, reviews, and evaluates information necessary to reach prospective, concurrent and retrospective decisions using objective evidence-based clinical… more
- Montana State University-Northern (Havre, MT)
- …is ten. The CRRN is responsible for the students and must have not have concurrent clinical responsibilities. The CRRN may also be assigned to monitor students ... Clinical Resource Registered Nurse (CRRN) part-time...position including any supplementary documentation and questions you should review before applying for the opening. To apply for… more
- State of Colorado (Pueblo, CO)
- Nurse I- Medium Acuity CMHHIP Nursing $25,000 Sign On Incentive Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4799998) Apply Nurse I- ... text message updates on CDHS recruiting events! CDHSCareers Description of Job Registered Nurse I-Full Time Medium Acuity - CMHHIP Adult males, ages 18 and over.… more
- Trinity Health (Farmington Hills, MI)
- …**POSITION PURPOSE** Responsible for reviewing all post-billed denials (inclusive of clinical denials) for medical necessity and appealing them based upon ... clinical expertise and clinical judgment within the...and appeal activities with Ministry Organization (MO) based Utilization Review /Case Management departments; + Reviews and understands utilization … 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...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- HCA Healthcare (Corpus Christi, TX)
- …your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer PRN opening. We review all applications. Qualified candidates will be ... **Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer PRN you want in...including Core Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews… more
- Tufts Medicine (Lowell, MA)
- …to internal staff who have worked with EVD, IABP and Impella patients. The Clinical Leader of ICU-G is a Registered Nurse with responsibility and accountability ... including: setting expectations, continuing education, credentialing, performance appraisals, auditing, concurrent monitoring, utilization review , risk management and… more
- Sutter Health (Sacramento, CA)
- …Graduate of an accredited school of nursing. **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California OR CNS- Clinical Nurse Specialist + BLS-Basic ... health plan/medical group payor experience, specifically with prior authorization and/or concurrent review ** + **Understand Medicare and DMHC plan/payor… more
- UPMC (Hanover, PA)
- …delays in discharge. Documents all Avoidable Days in CANOPY system. + Performs clinical review on admission and/or continued stay using InterQual criteria to ... **UPMC is hiring a part time Professional Care Manager for our Utilization Review department in Hanover! This is a part time, day shift position with a rotating… more
- Blue KC (MO)
- …authorization letters, and follows in FACETS UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside medical ... Uses standardized tools to complete assessments in the areas of clinical , functional, financial, support system, psychosocial and cognitive and environmental realms.… more
- Open Systems Healthcare (Washington, DC)
- Position Overview: The License Practical Nurse (LPN) Clinical Coordinator is responsible for supporting Open Systems Healthcare's (OSH) clinical operations ... the direction of the Director of Nursing, Administrator. This role provides clinical administrative support associated with case management, clinical document… more
- CDPHP (Albany, 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
- Northwell Health (Melville, NY)
- …care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. Performs concurrent and retrospective utilization ... management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness of admission and… more
- Matrix Providers (Aurora, CO)
- Utilization Review Nurse (RN) Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... fair, reliable schedules. Matrix Providers is hiring a Utilization Review Nurse (RN) to join our team...months total nursing experience in a direct patient care clinical setting and 12 months consecutive experience in utilization… more
- Travelers Insurance Company (Buffalo, NY)
- …Imagine loving what you do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual base salary range provided ... the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective, … more
- Community Health Systems (Naples, FL)
- …the direction of the Utilization Review (UR) Director/Manager the Utilization Review (UR) Nurse reviews all admissions for medical necessity, correct orders ... based on medical condition (inpt vs OBS). Facilitates concurrent reviews and authorizations for admissions. This position will support the development of policies… more
- State of Colorado (Pueblo, CO)
- NURSE II - Medium Acuity CMHHIP $25,000 Sign On Incentive Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4800103) Apply NURSE II - Medium ... time listed. + Description + Benefits + Questions Department Information Registered Nurse II-Full Time Medium Acuity- CMHHIP Geriatric Treatment Center - (GTC-CR)… more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. * Provides clinical information requested by the ... plan of care and coordination of services based on clinical needs and available resources. 3. Utilization Review...monitoring of discharge planning process in collaboration with the clinical nurse initiates the discharge planning process… more
- Community Health Systems (Franklin, TN)
- …as required based on hospital and/or corporate policies/procedures. + In the event of concurrent denials, the UR Clinical Specialist reviews the denial and works ... years previous nursing experiencePreferred Experience: 3 plus years Utilization review experience + Required License/Registration/Certification: Licensed Practical Nurse… more
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