- Centene Corporation (Sacramento, CA)
- …with interdepartmental teams on projects within utilization management as part of the clinical review team + Partners and works with Medical Affairs and/or ... based on diagnoses, prognoses, resources, and/or preferences + Manages and maintains concurrent review findings, discharge plans, and actions taken on member… 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
- InnovaCare (San Juan, PR)
- …customer focus to the business. MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the ... compliance with the Plan's SNP policies and MOC requirements. Clinical staff who do not complete the required annual...within forty-eight (48) hours of having performed the first concurrent review of notified admission cases.4. On… more
- Trinity Health (Fresno, CA)
- …current knowledge of clinical indicators and compliance requirements, conducting concurrent medical record review to ensure documentation compliance and ... position offers vital support for improvement of quality and clinical performance. This position collaborates with clinical ...field is preferred. 2. Current licensure as a Registered Nurse in the State of California is required. 3.… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The Clinical Documentation Specialist Registered Nurse facilitates improvement in the overall ... + Attends and participates in weekly educational conferences. + Participates in concurrent performance improvement activities and on-going MR review activities.… more
- Montana State University-Northern (Havre, MT)
- …is ten. The CRRN is responsible for the students and must have not have concurrent clinical responsibilities. The CRRN may also be assigned to monitor students ... Clinical Resource Registered Nurse (CRRN) part-time...position including any supplementary documentation and questions you should review before applying for the opening. To apply for… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring the ... receives and reviews notification of emergent hospital admissions, completes inpatient concurrent review , establishes discharge plans, coordinates transitions of… more
- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you have the career opportunities as a(an) Utilization Review Nurse BH WFH you want with your current employer? We have an ... colleagues. Do you want to work as a(an) Utilization Review Nurse BH WFH where your passion...and resources** + **Communicate with physicians regarding patient status, clinical documentation and concurrent denial mitigation strategies**… 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 ... Job Summary The Clinical Documentation Improvement Program (CDI) is designed to...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- HCA Healthcare (Corpus Christi, TX)
- …your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer PRN opening. We review all applications. Qualified candidates will be ... **Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer PRN you want in...including Core Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews… more
- Independent Health (Buffalo, NY)
- …first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse performs clinical reviews to determine the ... records: + Clear documentation of clinical information for medical necessity review of all requests, procedures, admissions and concurrent review .… more
- CDPHP (Albany, NY)
- …Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes ... completing inpatient level of care reviews, post-acute care initial and concurrent reviews for acute and subacute rehabilitation, transportation and DME requests.… more
- HCA Healthcare (Richmond, VA)
- …set us apart from any other healthcare provider. We are seeking a(an) Peer Review Coordinator Registered Nurse RN to join our healthcare family. **Benefits** ... - and empowers their passion for patient care. Apply today for our Peer Review Coordinator Registered Nurse RN opportunity. **Job Summary and Qualifications** +… more
- McLaren Health Care (Bay City, MI)
- …from an accredited educational institution + State of Michigan licensure as a Registered Nurse (RN) + Two years of recent clinical or utilization management ... documentation is sufficient to support the level of care being billed . Conducts concurrent reviews as directed in the hospital's UR Plan of medical records to… more
- Travelers Insurance Company (Buffalo, NY)
- …Imagine loving what you do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual base salary range provided ... the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective, … more
- Intermountain Health (Murray, UT)
- …coordination of transition of care and manage utilization through appropriate review of authorization requests. Job Essentials + Analyzes and evaluates medical ... and other health data to render medical necessity determinations using specific clinical criteria while adhering to regulatory turn-around times and provide … more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. * Provides clinical information requested by the ... plan of care and coordination of services based on clinical needs and available resources. 3. Utilization Review...monitoring of discharge planning process in collaboration with the clinical nurse initiates the discharge planning process… 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 ... Of Duties Duties include but are not limited to the following: + Conducts concurrent Level I review of patients within the program throughout their hospital… 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
- 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...productive workplace environment. Perform telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff,… more