- 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
- 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
- NJM Insurance (Trenton, NJ)
- … clinical information and updates needed to effectively and accurately perform concurrent review . + Identify medical and community needs and facilitate/assist ... uphold, modify, or overturn prior decisions. + Conduct Inpatient Care utilization review using NJM and evidence-based clinical guidelines to ensure appropriate… more
- RWJBarnabas Health (Livingston, NJ)
- …and social work functions, medical necessity determinations, and concurrent review . Qualifications: Required: + Minimum 5 years clinical experience in ... advocacy, oversight of nursing and social work functions, medical necessity determinations, and concurrent review . + Ensure that Case Management Department is in… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The ** Clinical Documentation Specialist Registered Nurse (RN)** facilitates improvement in the ... to the unit. **Responsibilities** A day in the life of a ** Clinical Documentation Specialist Registered Nurse (RN)** at **Hackensack Meridian** **_Health_**… more
- VNS Health (Manhattan, NY)
- … review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical ... team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state… more
- Atlantic Health System (Summit, NJ)
- The Clinical Documentation Specialist will facilitate modifications to clinical documentation, through concurrent interactions with physicians and other ... clinicians to reflect appropriate clinical severity, complications and co-morbidity....and all comorbid conditions after study. Completes the initial review within 24-48 hours of admission. Completes concurrent… more
- Northwell Health (Staten Island, NY)
- **Req Number** 144355 Registered Nurse Case Manager - FlexStaff Serves as liaison between the patient and facility/physician. Ensures a continuum of quality patient ... Responsibilities: + Facilitates patient management throughout hospitalization + Performs concurrent utilization management using evidence based medical necessity criteria… more
- Prime Healthcare (Bristol, PA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... accredited school of nursing and a current state Registered Nurse license + Grandfathered prior to April 1, 2015....of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred. +… more
- Northwell Health (Valley Stream, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. ... collaboration with the health care team. + Conducts chart review for appropriateness of admission and continued length of...and continued length of stay; Facilitates throughput. + Conducts clinical reviews and interacts with third party payers to… more
- CVS Health (Trenton, NJ)
- …Jersey as one of the following: Licensed Clinical Social Worker (LCSW), Registered Nurse (RN), Clinical Nurse Specialist (CNS), Licensed Clinical ... experience in managed care Utilization Management to include prior authorization, concurrent review OR demonstrated experience in providing behavioral health… more
- VNS Health (Manhattan, NY)
- … review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical ... team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state… more
- VNS Health (Manhattan, NY)
- … review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical ... team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state… more
- Vitalief (New Brunswick, NJ)
- …in New Brunswick, NJ. Job Responsibilities: + Under the direct supervision of the Nurse Manager of Clinical Research Center (CRC), you will be responsible for ... clients adapt to evolving requirements in the research and clinical trial industry with cutting-edge solutions. Reasons to Work...plus. + Ability to work on 12 to 15 concurrent trials - must have strong organizational and prioritization… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine… 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. c. Provides clinical information requested by the ... for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).… 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. 3. Provides clinical information requested by the ... for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).… more
- VNS Health (Manhattan, NY)
- …of organizational or state-wide trends that affect utilization trends and the impact that concurrent review and a high-quality plan of care for discharge has on ... management teams to generate timely requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable… more
- Molina Healthcare (New York, NY)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …+ Assess discharge planning needs at the patient's admission + Perform regular concurrent review on all patients and coordinate all needed services including ... Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of… more