- Centene Corporation (Sacramento, CA)
- …based on diagnoses, prognoses, resources, and/or preferences + Manages 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 + Provides education to providers on… more
- Ventura County (Ventura, CA)
- Senior Medical Management Nurse - VCHCP Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4591361) Apply Senior Medical Management ... health care services to County employees and their covered dependents. The Senior Registered Nurse -Ambulatory Care series is distinguished from other nursing… more
- Ascension Health (Manhattan, KS)
- …health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within assigned ... unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement...team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- BayCare Health System (Cotton Plant, AR)
- …other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient ... and clinical excellence. **BayCare Health System** is currently seeking a **Utilization Review Specialist Senior ** to join our outstanding and compassionate… more
- Ventura County (Ventura, CA)
- …variances to support active and timely performance improvement. Assists the TPM with concurrent review and the coordination patient care within the program as ... upon operational need and certification of skill. PAYROLL TITLE: Senior Registered Nurse - Hospital AGENCY/DEPARTMENT: Health...but are not limited to the following: + Conducts concurrent Level I review of patients within… more
- HCA Healthcare (Las Vegas, NV)
- …clinical data compiled by hospital medical records for the purpose of admission/ concurrent review for Medicare and self-pay patients + Identifies potential ... you passionate about delivering patient-centered care?** Submit your application for Registered Nurse Case Manager position and spend more time at the bedside with… more
- Sacramento County (Sacramento, CA)
- …Employment Qualifications Minimum Qualifications Either: One year of experience as a Senior Public Health Nurse in Sacramento County service. Or: Two ... improperly rejected may request the Employment Services Division to review its decision to reject the application. If the...+ I have one year of experience as a Senior Public Health Nurse in Sacramento County… more
- Johns Hopkins University (MD)
- …knowledge and application of OSHA/JHU/client regulations and safety standards. + Review each clinic's return on investment strategy to ensure appropriateness. + ... expiration, and Sharps/Stericycle logs to ensure quality control. + Review Cority / DOT forms and EMR to ensure...+ Serve as a source of information to JHU/client senior leadership and other internal/external personnel regarding the JHU/client… 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 ... DRG assignment, risk of mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of records every 3 days to… more
- Geisinger (Scranton, PA)
- …reporting potential risk and quality management issues identified from medical record review to appropriate departments through defined processes, and enters data as ... support quality improvement initiatives into appropriate system. + Conducts on-going case review for delays or variances in care; raises issues with appropriate… more
- Geisinger (Danville, PA)
- …reporting potential risk and quality management issues identified from medical record review to appropriate departments through defined processes, and enters data as ... support quality improvement initiatives into appropriate system. + Conducts on-going case review for delays or variances in care; raises issues with appropriate… more
- Sacramento County (Sacramento, CA)
- Senior Mental Health Worker-Licensed Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1036656) Apply Senior Mental Health Worker-Licensed ... plans with little direct supervision; provide direction to and review the work of assigned staff. + Establish and...the State of California to practice as a Registered Nurse , Vocational Nurse or Psychiatric Technician AND… more
- GE Vernova (Wilmington, NC)
- …oversight of suppliers thru procurement and construction to develop, perform, and review unit, module, system, and integration test plans, procedures, and reports ... Engineer-Procure-Construct (EPC) partner(s), and suppliers. + Perform detailed oversight, review , and verification of deliverables from suppliers to ensure their… more
- Tufts Medicine (Burlington, MA)
- …and regulatory compliance related to the CDI and coding functions. 2. Performs initial concurrent review of new patients every day and concurrent re-reviews ... knowledge and skills typically acquired through advanced education. A senior level role that requires advanced knowledge of job...Overview** The role of the position is responsible for concurrent and retrospect review and analysis of… more
- HCA Healthcare (Austin, TX)
- …of services and discharge planning for specified patient population. You will perform concurrent analysis of patient records for purposes of utilization review ... the assessment of patient clinical and psychosocial needs through review of patient information, personal contact with patient and...the discharge setting + You will perform first level concurrent analysis of patient records on assigned unit for… more
- UPMC (Mechanicsburg, PA)
- …position and requires a rotating weekend and holiday schedule.** **Purpose:** The Senior Care Manager (CM) coordinates the clinical and financial plan for patients. ... all Avoidable Days in CANOPY system. + Takes leadership role in concurrent denial process. Works with Care Management Director, Physician Advisor, Attending… more
- Sacramento County (Sacramento, CA)
- …clinic. OR: Two years of experience in the class of Mental Health Counselor, Psychiatric Nurse , Senior Mental Health Counselor, Senior Psychiatric Nurse , ... Licensed Clinical Social Worker, Marriage and Family Therapist, or Registered Nurse . AND Either: Two years of experience coordinating and/or supervising mental… more
- Centene Corporation (Atlanta, GA)
- …between utilization management team, members, and providers + Monitors prior authorization, concurrent review , and/or retrospective clinical review nurses ... to utilization management + Works with utilization management team and senior management to identify opportunities for process and quality improvements within… more
- University of Michigan (Ann Arbor, MI)
- …Care Services (PACS), including the management, performance, and completion of multiple concurrent projects. Will lead project management activities and serve as a ... written communications and presentations for a variety of stakeholders, including senior leadership. + Ensures alignment of projects to institutional policies,… more
- Dignity Health (Bakersfield, CA)
- …for the day-to-day operations of the UM nursing teams including pre service utilization review , concurrent inpatient review and retro claim review . ... effective communication and a strong leadership presence with executive partners, senior leaders, internal and external customers to coordinate and adequately… more
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