- 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 ... Eligibility for benefits may vary by location._** We are seeking a(an) CDI Concurrent Review and Query Specialist for our team to ensure that we continue to… 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 ... 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 potential!… more
- InnovaCare (San Juan, PR)
- …focus to the business. MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient ... Inpatient within forty-eight (48) hours of having performed the first concurrent review of notified admission cases.4. On a daily basis, concurrently reviews… more
- 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 ... care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.… more
- Trinity Health (Fresno, CA)
- …maintaining current knowledge of clinical indicators and compliance requirements, conducting concurrent medical record review to ensure documentation compliance ... and facilitating necessary interventions. This position will oversee data collection tools, deliver regular feedback to clinical department leaders and staff, and contribute to the ongoing execution of Saint Agnes Medical Center's Quality program. Through… more
- Martin's Point Health Care (Portland, ME)
- …receives and reviews notification of emergent hospital admissions, completes inpatient concurrent review , establishes discharge plans, coordinates transitions of ... + Review prior authorization requests (prior authorization, concurrent review , and retrospective review ) for medical necessity referring… more
- BayCare Health System (Clearwater, FL)
- …other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient ... clinical excellence. **BayCare Health System** is currently seeking a **Utilization Review Specialist Senior** to join our outstanding and compassionate team. **The… more
- Prime Healthcare (Boonton Township, NJ)
- …and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, ... external case managers and managed care organizations for pre-authorization, concurrent reviews and appeals/denials management throughout the duration of a… 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 ... regarding transition to alternative levels of care. + Perform concurrent utilization review applying identified criteria at prescribed review points,… more
- Sutter Health (Berkeley, CA)
- …and proper utilization of physician, nursing, and ancillary services. Responsible for concurrent review on specific patients. Develops, coordinates and monitors ... with hospital administration, medical staff, patient registration and representatives of review organizations and others to ensure effective utilization of services… more
- US Tech Solutions (Orange, CA)
- …retrospective inpatient service reviews. Authorizes requested services according to Health's Concurrent Review team guidelines. Contacts the health networks ... discharge dates, dispositions and conducts follow-up phone calls per concurrent review team standards. Participates in a mission-driven culture of high-quality… more
- Ellis Medicine (Schenectady, NY)
- …on first working day post admission with communication to insurance as needed. Does concurrent review on criteria and nursing judgment. Make all contact with ... the anticipation, identification, and resolution of issues through pre-admission, admission, concurrent and post discharge medical record review 3. Services… 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
- Centene Corporation (Sacramento, CA)
- …providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically appropriate determinations + ... that requires California RN Licensure. **Position Purpose:** Performs a clinical retrospective review of services previously provided to determine if the level of… more
- St. Luke's University Health Network (Allentown, PA)
- …+ Conducts reviews of cases lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical ... of a patient's ability to pay for health care. The Surgical Review Specialist prospectively reviews, validates, and audits procedure code assignment in accordance… more
- Molina Healthcare (OH)
- …seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge ... of Interqual / MCG guidelines. COMPACT / Multi state RN LICENSURE IS PREFERABLE to support multiple states._** **_Work Schedule: 4 days week/ 10 hours per day some weekends and holidays are required. INITIAL TRAINING DAYS will be 5 days / week 8am to 5pm._**… more
- Molina Healthcare (OH)
- …seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge ... of Interqual / MCG guidelines. COMPACT / Multi state RN LICENSURE IS PREFERABLE to support multiple states._** **_Home office with private desk area, and high speed internet connectivity required._** **_WORK HOURS 5 days / daytime work schedule. This… more
- Molina Healthcare (Milwaukee, WI)
- …seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge ... of Interqual / MCG guidelines. WI or COMPACT RN LICENSURE IS REQUIRED within 30 days of employment._** **_Ability/knowledge to cross train, inpatient medical to inpatient BH or inpatient Medical to PA is preferred._** **_Excellent computer skills and attention… 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 ... sources. Identifies patients (as early as possible in the admission) requiring discharge planning. Determines admission necessity based upon severity of illness and intensity of service criteria. Ensures a multi-disciplinary approach in planning of care across… more
- Covenant Health Inc. (Knoxville, TN)
- …the validity and reliability of the case-mix index, CDI is accountable for concurrent review of health records, reviewing documentation that supports the ... compliance in hospital services. CDI is responsible for facilitating concurrent documentation reviews in the setting of an acute...reviews in the setting of an acute care facility. Concurrent reviews assure the completeness of the medical record,… more
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