- 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
- WMCHealth (Valhalla, NY)
- Nurse , Performance Improvement Trauma Coordinator Company: NorthEast Provider Solutions Inc. City/State: Valhalla, NY Category: Nursing/Nursing Management ... and works closely with the Trauma Registry to ensure accurate concurrent data collection and identification of performance improvement occurrences. The Performance… more
- Northwell Health (Plainview, 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
- Northwell Health (Lake Success, NY)
- … clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests clarification ... of clinical documentation from the physician(s) on a ...date. *Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications… more
- Mount Sinai Health System (New York, NY)
- …preferred. + Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign ... 4. Conducts Root Cause Analysis investigations which include assessing need for focused review by departments, and/or clinical chairpersons for peer reviews. 5.… more
- Hackensack Meridian Health (Red Bank, NJ)
- …experience. **Licenses and Certifications Required:** + Current state Registered Nurse license. + Certified Clinical Documentation Specialist (CCDS) ... healthcare and serve as a leader of positive change. The ** Clinical Documentation Specialist RN** facilitates improvement in the overall quality, completeness… more
- Northwell Health (Melville, NY)
- …care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. + Performs concurrent and retrospective ... utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness of… 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
- Northwell Health (Staten Island, NY)
- …Patients Discharge Instruction Sheet and the Patient Transfer Sheet. + Ensures Patient Review Instrument (PRI) is completed and reflects clinical profile of the ... clinical pathways, variance analysis and trending, quality management/utilization review and home care/discharge planning, preferred. + Keeps abreast of… more
- MVP Health Care (Tarrytown, NY)
- …. The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This individual ... will make triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum...health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required + New York State license required… more
- Molina Healthcare (Yonkers, NY)
- …requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care ... for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation… more
- Catholic Health Services (West Islip, NY)
- …Revenue Cycle and Patient Access departments to ensure the most advantageous clinical and financial outcomes. + Supports all CH and consultant initiatives addressing ... Conditions of Participation. + Implements care management programs, including utilization review , intake and discharge planning. + Evaluates patient care data to… more