- 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 standards ... Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management...the appropriate admit status and medical necessity for admission, concurrent , and discharges, securing the appropriate documentation and planning… 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)
- …necessity, referring to the Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part of the ... Registered Nurses (RN) licensed in Colorado, be able to practice using a nurse compact state license or have a license from any United States jurisdiction… 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)
- …include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness ... ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements. Case Managers act as consultants to the clinical… more
- Stanford Health Care (Palo Alto, CA)
- …include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness ... ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements. Case Managers act as consultants to the clinical… more
- Stanford Health Care (Palo Alto, CA)
- …charging error, substandard documentation and inaccurate procedural billing. + Performs concurrent review of hospital bills to document non-billed, underbilled, ... development and reporting of findings. + Prepares written reports of review findings and recommendations and presents to management and maintains monitoring… 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
- Trinity Health (Syracuse, NY)
- …administrative requirements for Utilization Management and works collaboratively with Utilization Management/ Concurrent Review Nurse , physicians, staff and ... possible concurrent denials, forwards information to the appropriate Utilization Management/ Concurrent Review Nurse within identified process standards *… 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... (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... 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
- 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
- UNC Health Care (Kinston, NC)
- …the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria ... of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service,...3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review ,… more
- Catholic Health (Kenmore, NY)
- …in the hospital setting. Utilizing foundational nursing clinical skills Utilization Review nurse collaborates with the interdisciplinary team to maintain ... 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
- 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
- University of Utah Health (Salt Lake City, UT)
- …continued stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient continues ... cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by nursing judgment and/or...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Ventura County (Ventura, CA)
- …and patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review , case management, ... may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent , retrospective, out of network and medical… more
- LA Care Health Plan (Los Angeles, CA)
- …in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff, physicians, providers, ... Utilization Management Nurse Specialist RN II Job Category: Clinical Department:...productive workplace environment. Perform telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff,… more
- Rush University Medical Center (Chicago, IL)
- …the medical necessity, appropriateness, and quality of care. Applies criteria, performs concurrent review process. Works with physicians and Medical Director ... depending on the circumstances of each case. **Summary:** The Nurse Care Manager 1 works with physician practices and...regarding Case issues and concurrent denials an indicated. 6. Applies pathways/guidelines, assesses variances,… more
- Beth Israel Lahey Health (Cambridge, MA)
- …reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...to collect data for reporting quality measures, including both concurrent medical record review and periodic medical… more
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