- UNC Health (Chapel Hill, NC)
- …and regulatory knowledge to reduce significant financial risk caused by concurrent and retrospective denial of payments for rendered services. This individual ... base tasks, or other electronic communication and via telephone.Responsibilities:1. Clinical Review Process - Uses approved criteria and conducts admission review… more
- Waste Management (Arlington, OR)
- …assigned which may include the following, but is not limited to: Operations review , continual improvement, and Cross Functional Team Safety Near Miss / Unsafe ... Condition and/or Peer Observation Program review , tracking, and data analysisWMU Administration (curriculum, training groups, assignments, trouble-shooting) and… more
- Waste Management (Arlington, OR)
- …assigned which may include the following, but is not limited to: Operations review , continual improvement, and Cross Functional Team Safety Near Miss / Unsafe ... Condition and/or Peer Observation Program review , tracking, and data analysisWMU Administration (curriculum, training groups, assignments, trouble-shooting) and… more
- Dev Technology Group (Reston, VA)
- …(BOE), bill of materials (BOM), and subcontractor requests for pricing. Review cost inputs for completeness, reasonableness, consistency, and accuracy and facilitate ... development and writing of price narratives and business volumes. May assist in the review and contribution to staffing plans or sections as it relates to cost… more
- InnovaCare (San Juan, PR)
- …focus to the business. MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient ... Inpatient within forty-eight (48) hours of having performed the first concurrent review of notified admission cases.4. On a daily basis, concurrently reviews… more
- Centene Corporation (Cheyenne, WY)
- …based on diagnoses, prognoses, resources, and/or preferences + Manages 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 + Provides education to providers on… more
- Centene Corporation (SC)
- …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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …at any time with or without notice. Primary Responsibilities + Performs concurrent utilization reviews (Acute, SNF, LTACH, ARF) and first level determination ... Disease Management, and Quality Department as needed. + Develop and review member centered documentation and correspondence reflecting determinations in compliance… more
- LifePoint Health (Wilson, NC)
- …Director and according to established policies and procedures, performs admission and concurrent review of all patients to determine the appropriateness of ... Reports to Director of Behavioral Health 1. Performs admission, concurrent and focused review using criteria as determined by current department procedures and… more
- BayCare Health System (Cotton Plant, AR)
- …other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient ... clinical excellence. **BayCare Health System** is currently seeking a **Utilization Review Specialist Senior** to join our outstanding and compassionate team. **The… more
- Martin's Point Health Care (Portland, ME)
- …As needed, may also review prior authorization requests (prior authorization, concurrent review , and retrospective review ) for medical necessity ... Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of the Utilization... Nurse works as a member of the Utilization Review Team and is responsible for reviewing claims disputes… more
- Ellis Medicine (Schenectady, NY)
- …on first working day post admission with communication to insurance as needed. Does concurrent review on criteria and nursing judgment. Make all contact with ... the anticipation, identification, and resolution of issues through pre-admission, admission, concurrent and post discharge medical record review 3. Services… more
- Mirror (Newton, KS)
- …measures regarding appeals, denials, higher level of care admission certification and concurrent review timeliness. + Compile and report daily review ... the URC is responsible for the implementation, and maintenance of utilization review programs to facilitate the use of behavioral health resources and increasing… more
- Centene Corporation (Austin, TX)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... Texas** **RN, LCSW, LMHC, PLC, LMFT, LMHP** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse. Monitors… more
- St. Luke's University Health Network (Allentown, PA)
- …+ Conducts reviews of cases lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical ... of a patient's ability to pay for health care. The Surgical Review Specialist prospectively reviews, validates, and audits procedure code assignment in accordance… more
- Molina Healthcare (CA)
- …we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge ... **JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSE** **For this position… more
- Prime Healthcare (Lynwood, CA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/163839/rn-case-manager utilization- review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySt. Francis Medical Center LocationUS-CA-Lynwood… more
- LA Care Health Plan (Los Angeles, CA)
- …in any inpatient setting. Performs telephonic and/or on site admission and concurrent review , and collaborates with onsite staff, physicians, providers, member/ ... review if indicated. Perform telephonic and/or on site admission and concurrent review , and collaborates with onsite staff, physicians, providers, the member… more
- Billings Clinic (Billings, MT)
- … Review / Management RN. This position is to conduct initial, concurrent , retrospective chart review for clinical financial resource utilization. Coordinates ... for status and level of care *Priority 2: Performs Utilization Review (UR) Activities *Completes concurrent Level of Care (LOC) & status reviews utilizing payer… more
- University of Utah Health (Salt Lake City, UT)
- …continued stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient continues ... expected cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by nursing judgment and/or collaboration with… more
