- Centene Corporation (Sacramento, CA)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... position that requires a CA RN Licensure.** **Position Purpose** : Performs concurrent reviews, including determining member's overall health, reviewing the type of… more
- InnovaCare (San Juan, PR)
- …customer focus to the business. MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the ... compliance with the Plan's SNP policies and MOC requirements. Clinical staff who do not complete the required annual...within forty-eight (48) hours of having performed the first concurrent review of notified admission cases.4. On… more
- HCA Healthcare (Nashville, TN)
- …environment where diversity and inclusion thrive? Submit your application for our CDI Concurrent Review and Query Specialist opening with HCA Healthcare today ... may vary by location._** We are seeking a(an) CDI Concurrent Review and Query Specialist for our...to physicians for conflicting, imprecise, incomplete, illegible, or inconsistent clinical documentation. This individual need to function in a… more
- HCA Healthcare (Nashville, TN)
- …colleagues invested over 156,000 hours volunteering in our communities. As a(an) CDI Concurrent Review and Query Specialist with Work from Home you can ... you need to succeed in our organization. We are looking for an enthusiastic CDI Concurrent Review and Query Specialist to help us reach our goals. Unlock your… more
- Trinity Health (Fresno, CA)
- …current knowledge of clinical indicators and compliance requirements, conducting concurrent medical record review to ensure documentation compliance and ... position offers vital support for improvement of quality and clinical performance. This position collaborates with clinical ...field is preferred. 2. Current licensure as a Registered Nurse in the State of California is required. 3.… more
- Centene Corporation (Sacramento, CA)
- …administered with quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against ... providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically appropriate determinations +… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring the ... receives and reviews notification of emergent hospital admissions, completes inpatient concurrent review , establishes discharge plans, coordinates transitions of… 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
- 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
- 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 Professional Care Manager to support the Utilization Review process! This is a full time, day shift position with a rotating weekend and holiday… more
- Premier Health (Troy, OH)
- Position: ASSOCIATE NURSE MGR/ UTILIZATION REVIEW RN Dept: Inpatient Behavioral Health Shift: Full time 72 hours/pp: 7am-7:30pm Facility: Upper Valley Medical ... Center **_*NOTE: THIS IS A COMBINATION POSITION: 24 HOURS/PP ASSOCIATE NURSE MANAGER AND 48 HOURS/PP UTILIZATION REVIEW RN._** The **Associate Nurse Manager… 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
- 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
- Banner Health (AZ)
- … Nurse and your knowledge of Case Managment and Utilization Management to review clinical records to ensure patients are in the correct status. Your ... by including remote and hybrid opportunities. As a Registered Nurse Reviewer, you will work a critical part of...documentation required for claims payment of services approved through concurrent review and case management. 7. Works… more
- NJM Insurance (Trenton, NJ)
- … clinical information and updates needed to effectively and accurately perform concurrent review . + Identify medical and community needs and facilitate/assist ... uphold, modify, or overturn prior decisions. + Conduct Inpatient Care utilization review using NJM and evidence-based clinical guidelines to ensure appropriate… more
- Sharp HealthCare (San Diego, CA)
- …position, and employer business practices. **What You Will Do** Perform admission and concurrent review of patients, based upon needs regardless of payor ... BLS Healthcare) - American Heart Association; California BBS Licensed Clinical Social Worker (LCSW) - CA Board of Behavioral...(LMFT) - CA Board of Behavioral Sciences; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours**… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- Summary The Emergency Department Utilization Management (ED-UM) Registered Nurse (RN) is responsible for providing competent, evidence-based practices within the ... Uses UM Criteria to perform reviews while further developing technical and clinical competencies and team building with the attending team. Responsibilities Duties… more
- Alameda Health System (Oakland, CA)
- …utilization review functions, including response to payor requests for concurrent and retrospective review information including Medicare and MediCal ... Nurse , Care Management + Oakland, CA + Highland...develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care,… more
- SSM Health (MO)
- …as well as the level of services rendered. The CDI Specialist assesses clinical documentation through extensive review of the medical record, interaction with ... Tennessee, Texas, Utah, Virginia, West Virginia, and Wisconsin. **Job Summary:** Performs concurrent analytical reviews of clinical and coding data to improving… more
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