- 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
- FlexStaff (Uniondale, NY)
- …Under the direction of the Senior Director of Clinical Review , the Clinical Review Nurse is responsible for complying with the day-to-day operations ... The Senior Director of Clinical Review will monitor the Clinical Review Nurse 's activities and outcomes, ensuring compliance with established… 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 admission and… 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
- 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
- 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
- Northwell Health (Manhasset, 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
- 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
- VNS Health (Manhattan, NY)
- OverviewLeads interdepartmental quality improvement activities such as development and engagement, clinical review , clinical risk management, and patient ... Develops forms, record abstracts, reports, and other tools used to implement concurrent and retrospective patient care review , including the design, testing… more
- Catholic Health Services (Roslyn, NY)
- Overview REGISTERED NURSE CLINICAL DATA COORDINATOR St. Francis Hospital & Heart Center(R) is New York State's only specialty designated cardiac center. A member ... procedures and guides as appropriate to their role. Performs appropriate targeted concurrent review to improve accuracy and compliance if indicated. Performs… 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
- Nuvance Health (Norwalk, CT)
- …are executed to the appropriate level within the care continuum. Provides clinically based concurrent review of the medical record to assess and procure accurate ... *Description* Summary: The Clinical Care Coordinator - Unit is responsible for...between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate status is… 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
- Catholic Health Services (West Islip, NY)
- …an effective multidisciplinary pediatric trauma performance improvement program (PIP) through concurrent data collection and systems review . Utilizes available ... and regional professional staff development. * Participates in case review , practice guidelines development and community trauma education and...* Current NYS license to practice as a Registered Nurse . * Five years of clinical nursing… more