- Centene Corporation (Reno, 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
- 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
- HCA Healthcare (Nashville, TN)
- …colleagues invested over 156,000 hours volunteering in our communities. As a(an) CDI Concurrent Review and Query Specialist with Work from Home you can ... you need to succeed in our organization. We are looking for an enthusiastic CDI Concurrent Review and Query Specialist to help us reach our goals. Unlock your… more
- Centene Corporation (Madison, WI)
- …on workplace flexibility. **Position Purpose:** Manages Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... and facilitates operations within utilization management. + Manages prior authorization, concurrent review , and retrospective clinical review… 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
- Actalent (Atlanta, GA)
- …details if applicable. Qualifications: + Active RN License + Prior Utilization management/ Concurrent review experience + Experience with MCG Why Actalent? + ... Actalent is currently hiring for Remote Utilization Review RNs! Job Description: + Reviewing authorization requests + Utilizing evidence-based criteria and making a… 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
- 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
- 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
- Open Systems Healthcare (Washington, DC)
- Position Overview: The License Practical Nurse (LPN) Clinical Coordinator is responsible for supporting Open Systems Healthcare's (OSH) clinical operations ... the direction of the Director of Nursing, Administrator. This role provides clinical administrative support associated with case management, clinical document… more
- Northwell Health (Bay Shore, NY)
- …and assesses of patients admitted to the Hospital. Job Responsibility + * Performs concurrent review on all patients and share all problematic cases with the ... * Arranges for patients post hospital needs, ie visiting nurse , physical therapy, medical/social model day care, personal care...and all related duties as required. + * Performs Clinical Care Coordination assessment within 72 hours of admission… more
- Premier Health (Troy, OH)
- Position: ASSOCIATE NURSE MGR/ UTILIZATION REVIEW RN Dept: Inpatient Behavioral Health Shift: Full time 72 hours/pp: 7am-7:30pm Facility: Upper Valley Medical ... Center **_*NOTE: THIS IS A COMBINATION POSITION: 24 HOURS/PP ASSOCIATE NURSE MANAGER AND 48 HOURS/PP UTILIZATION REVIEW RN._** The **Associate Nurse Manager… more
- Travelers Insurance Company (Albany, 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
- 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
- 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
- Veterans Affairs, Veterans Health Administration (Nashville, TN)
- …disorders. Theoverarching goals of the program are to deliver excellent clinical , educational and research services for all aspects of Neurology. Responsibilities ... The Advanced Practice Nurse (APN) Certified Nurse Practitioner (NP) practices...training and certification. Core functions are outlined in the clinical privileges that correspond with this position. The NP… 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
- Rush University Medical Center (Chicago, IL)
- …the medical necessity, appropriateness, and quality of care. Applies criteria, performs concurrent review process. Works with physicians and Medical Director ... clinical needs throughout the continuum of care. The Nurse Care Manager 1 functions as a liaison between...regarding Case issues and concurrent denials an indicated. 6. Applies pathways/guidelines, assesses variances,… more
- Sharp HealthCare (San Diego, CA)
- …position, and employer business practices. **What You Will Do** Perform admission and concurrent review of patients, based upon needs regardless of payor ... BLS Healthcare) - American Heart Association; California BBS Licensed Clinical Social Worker (LCSW) - CA Board of Behavioral...(LMFT) - CA Board of Behavioral Sciences; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours**… more