- Centene Corporation (Carson City, NV)
- …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
- Molina Healthcare (Sparks, NV)
- …experience with MCG guidelines. At least 2 years of experience with inpatient concurrent review , prior authorization and managed care; Acute care hospital ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes....equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Oracle (Carson City, NV)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will… more
- Elevance Health (Las Vegas, NV)
- … clinical staff. + Conducts and may approve pre-certification, concurrent , retrospective, out of network and/or appropriateness of treatment setting reviews ... not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians....equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. +… more
- Molina Healthcare (North Las Vegas, NV)
- …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