- Centene Corporation (Olympia, WA)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- Centene Corporation (New York, NY)
- …needed to discuss member care being delivered. + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings. + Assists with providing education to… more
- Trinity Health (Albany, 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
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a CDI Concurrent Review and Query Specialist? At HCA Healthcare, you come first. HCA Healthcare ... a difference. We are looking for a dedicated CDI Concurrent Review and Query Specialist like you...care facility required Licenses, Certifications, & Training: + Registered Nurse - Currently licensed as a Registered Professional … more
- CDPHP (Albany, 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
- Beth Israel Lahey Health (Burlington, MA)
- …being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for ... people's lives.** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on… more
- Beth Israel Lahey Health (Burlington, MA)
- …being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for ... **Job Description:** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based… more
- UPMC (Hanover, PA)
- **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 ... measures information for JCAHO requirements. + Takes leadership role in concurrent denial process. Works with Care Management Director, Physician Advisor, Attending… more
- Matrix Providers (Aurora, CO)
- Utilization Review Nurse (RN) Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... provider-to-patient ratios and fair, reliable schedules. Matrix Providers is hiring a Utilization Review Nurse (RN) to join our team of talented professionals… more
- Actalent (Nashville, TN)
- …Facility, Long-Term Acute Care Hospital, Skilled Nursing Facility). + 3 years of concurrent review experience and/or discharge planning. + 2 years of utilization ... Actalent is Hiring a Team of Post Acute Utilization Review Nurses - Open to both RNs and LPNs!...and Start Date of 3/24!! Job Description The PAC Nurse is a telephonic position responsible for recommending discharge… more
- FlexStaff (Uniondale, NY)
- **Req Number** 147980 JOB PURPOSE: Under the direction of the Senior Director of Clinical Review , the Clinical Review Nurse is responsible for complying with ... The Senior Director of Clinical Review will monitor the Clinical Review Nurse 's activities and outcomes, ensuring compliance with established regulatory and… more
- Actalent (Tampa, FL)
- …Facility, Long-Term Acute Care Hospital, Skilled Nursing Facility). + 3 years of concurrent review experience and/or discharge planning. + 2 years of utilization ... is Hiring a Team of PAC LPN's/Nurses - Remote!Job Description The PAC Nurse is a telephonic position responsible for recommending discharge plans, assisting with the… 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
- University of Utah Health (South Salt Lake, 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
- Mount Sinai Health System (New York, NY)
- …the clinical information requested by the managed care companies as part of the concurrent review in a timely fashion. * Provides clinical information requested ... The Case Manager is responsible for all aspects of case management/ utilization review for an assigned group of inpatients, ED patients and Observation ( RETU)… 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
- 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...physician, and the Care Management physician advisor of any concurrent denials.Prepares case reports;documents treatment plan, progress notes and… more
- Sacramento County (Sacramento, CA)
- Nurse Practitioner Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1780920) Apply Nurse Practitioner Salary $127,576.80 - $155,096.64 ... on: 9/27/2024, 10/25/2024, 11/22/2024, 12/27/2024, 1/31/2025, 2/28/2025, 3/28/2025, 4/25/2025 Nurse Practitioners provide a range of health care services involving… more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse D/CF Salary ... 5:00 pm on: 2/3/25, 4/7/25, 6/2/25, 8/4/25, 10/6/25, 12/1/25 Supervising Registered Nurse - Detention/Correctional Facility is the first level supervisory class in… more
- Sacramento County (Sacramento, CA)
- Supervising Public Health Nurse Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/600083) Apply Supervising Public Health Nurse Salary ... One year of experience as a Senior Public Health Nurse in Sacramento County service. Or: Two years of...improperly rejected may request the Employment Services Division to review its decision to reject the application. If the… more
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