- Actalent (Tigard, OR)
- Job Title: Clinical Review Nurse - Concurrent Review Work Environment + This is a 100% remote position + The schedule is Tuesday to Saturday, 10 AM ... , case management, and concurrent review . Job Description The Clinical Review Nurse will perform concurrent reviews to assess the member's… more
- Actalent (Tigard, OR)
- Job Title: Clinical Review Nurse - Concurrent Review (West Coast) Job Description We are seeking a dedicated Clinical Review Nurse to ... experience with at least 2 years in acute care. + Strong skills in clinical review , utilization management, and concurrent review . + Self-starter with… more
- Centene Corporation (Sacramento, CA)
- …hold a current CA license.** **Must have** **5-7 years related** **experience in UM- Concurrent Review . 2+ years of acute care experience required. 10% Travel ... on projects within utilization management as part of the clinical review team + Partners and works...diagnoses, prognoses, resources, and/or preferences + Manages and maintains concurrent review findings, discharge plans, and actions… more
- Centene Corporation (Olympia, WA)
- …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
- Actalent (Porterville, CA)
- Remote Concurrent Review Nurse Job...on projects within utilization management as part of the clinical review team + Partners and works ... Description We are seeking a dedicated Concurrent Review Nurse to perform concurrent ...Additional Skills & Qualifications + Case management experience. + Clinical review skills. + For Health Net… more
- Children's Mercy Kansas City (Kansas City, MO)
- …can improve the lives of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, ... authorization per contracts for medically appropriate level of care. Manages concurrent clinical denials through completion of verbal reconsideration process.… more
- Actalent (Bakersfield, CA)
- …+ Associate or Bachelor's degree in Nursing + 2-4 years of experience in concurrent review or utilization management + Strong communication skills, attention to ... month (cameras on, no time off during ramp-up) Key Responsibilities: + Conduct concurrent reviews to assess medical necessity and appropriate level of care +… 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
- AdventHealth (Celebration, FL)
- …in the defeat of illness and disease **The role you'll contribute:** The Clinical Nurse Education Facilitator (CNEF) is an expert clinician, highly skilled ... thinking, critical reflection, and life-long learning to adapt quickly to changing clinical environments and escalating patient care needs. The CNEF will use a… 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 ... work on site position located in Danville, Pennsylvania. The Clinical Documentation Improvement Program (CDI) is designed to improve...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- Beth Israel Lahey Health (Boston, MA)
- …being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for ... a Registered Nurse (RN), Massachusetts + Three years of recent clinical or utilization management experience _Preferred:_ + Bachelor's degree in nursing or… more
- Blue KC (Workman, MN)
- …authorization letters, and follows in FACETS UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside medical ... Uses standardized tools to complete assessments in the areas of clinical , functional, financial, support system, psychosocial and cognitive and environmental realms.… 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...Dayshift; Monday through Friday. Candidates must hold a Registered Nurse license in Pennsylvania or a Multistate License. A… more
- Ansible Government Solutions (Memphis, TN)
- …success as if it is their own. Responsibilities + Act as the Registered Nurse Advisor for the facility's CDI program, focusing on both inpatient and outpatient ... services + Review health records concurrently to identify opportunities for improved...identify opportunities for improved documentation and coding accuracy using clinical knowledge and critical thinking skills + Support CDI… more
- CDPHP (Latham, NY)
- …The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes ... exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care… more
- HonorHealth (AZ)
- …urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, ... Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services… more
- UNC Health Care (Kinston, NC)
- …assures timely movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of ... the right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care,… more
- AdventHealth (Ocala, FL)
- …the team:** + Assures compliance with professional practice evaluation through concurrent and retrospective review , identification of deficiencies, and ... Practice Evaluation is responsible for facilitating the medical staff Peer Review , Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice… more
- Beth Israel Lahey Health (Plymouth, MA)
- …data to establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal ... the care provided to the hospitalized patient. + Conducts concurrent reviews to determine the continued need for acute...degree in healthcare preferred. + Three years recent, broad clinical experience in the hospital setting + Experience with… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more