- 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 ... perspective on workplace flexibility. NOTE: This is a fully remote role. Preference will be given to applicants (1)...member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions… more
- Actalent (Minnetonka, MN)
- Remote Utilization Management Nurse Job Description As a Utilization Management Nurse for Post Acute care, you will be responsible for reviewing and ... acute inpatient rehabilitation, and long-term acute care hospitals. Responsibilities + Review and document prior authorization and concurrent stay requests.… more
- CVS Health (Phoenix, AZ)
- …outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and ... members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role, you'll be at the forefront of… more
- Vitalief (Philadelphia, PA)
- …and grow sustainably. The Role We are seeking an experienced Clinical Research Nurse to join our exceptional team as a full-time Vitalief employee. In this ... plans. + Hybrid schedule : 4 days on-site (Philadelphia), 1 day remote weekly. + Market-competitive salary , commensurate with experience. Responsibilities: + Under… 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 ... PA, but may allow for some days to be remote in the future. The role is full-time, 40...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- International Medical Group (Indianapolis, IN)
- …an active RN license in good standing in Indiana. + Location: Hybrid or Remote working options. + Corporate office is in Indianapolis, IN. + Relocation Expenses ... of the use of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between the Insured, the… more
- BrightSpring Health Services (Mount Laurel, NJ)
- …Registered Professional Nurse + Excellent communicator with ability to handle concurrent tasks and responsibilities + Ability to travel within assigned area + ... of health care within all programs. + Travels to programs to review individual records, collaborate with para-professional team members, and evaluate nursing… more
- Providence (Mission Hills, CA)
- **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... Qualifications:** + Associate's Degree in Nursing. + California Registered Nurse License upon hire. + 2 years of experience...hire. + 2 years of experience working in a remote UR environment or working as an acute hospital… more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests ... needs of FH members and their families. The PA Nurse is responsible for assuring the receipt of high...from medical care providers as needed for the clinical review process * Conducts pre-authorization and concurrent … more
- TEKsystems (West Des Moines, IA)
- …minimal training. The Clinical Documentation Specialist (CDS) is responsible for performing concurrent review of medical records to ensure complete and accurate ... support automation within the business office. Contract needs may extend longer. 100% remote role; - prefer candidates that sit in Iowa, Illinois, and Wisconsin.… more
- Trinity Health (Livonia, MI)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Purpose** Work Remote Position (Pay Range: $24.5303-$36.7954) Provides oversight & support of ... services. Responsible for charge capture in Revenue Integrity assigned areas. Review 's chart, including nursing notes, physician orders, progress notes, and surgical… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** **This position is remote . Candidates must be local to New England States for consideration** The Clinical ... Documentation Improvement (CDI) Specialist Registered Nurse (RN) assists with the appropriate identification of diagnoses, conditions, and/or procedures that are… more
- Vanderbilt University Medical Center (Nashville, TN)
- …procedures independently. Documents the patient's clinical status and care provided. Performs concurrent review of patient records for documentation to support ... of emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC-Registered Nurse - Licensure-Others **Work Experience:** Relevant Work Experience **Experience… more
- Trinity Health (Columbus, OH)
- …accuracy, and integrity of medical record documentation through extensive record review . Through extensive interaction with physicians and other members of the ... within the model of the ANCC Magnet Recognition Program(R). + Conducts concurrent reviews of selected patient records to address legibility, clarity, completeness,… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization review plans… more
- Centene Corporation (Indianapolis, IN)
- …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
- Nuvance Health (Danbury, CT)
- …payers. * If concurrent inpatient case does not meet medical necessity review criteria during the first level review , discuss with the attending MD ... DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED* * *Hybrid/ Remote * * *Summary:* The purpose of the Denial Prevention...* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are… more
- SSM Health (IL)
- **It's more than a career, it's a calling** IL- REMOTE STL PLAN **Worker Type:** Regular **Job Highlights:** Must have prior experience as a Clinical Documentation ... (patient safety indicator) or experience with Vizient specialized mortality reviews. **Eligible Remote States:** Candidates are required to reside on one of SSM's… more
- SSM Health (MO)
- …and provides feedback to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, ... **It's more than a career, it's a calling.** MO- REMOTE **Worker Type:** Regular **Job Summary:** Performs as...rate/expected rate (O/E ratios), industry trends, variable and diagnosis review group (DRG) frequency. + Serves as a liaison… more
