- Actalent (Austin, TX)
- Clinical Review Nurse - Concurrent Review Location: Remote - Compact Nursing License required; must be able to work CST hours Schedule: ... Medicaid About the Role We are seeking a Clinical Review Nurse to perform concurrent ...with clinical policies and guidelines. This role is fully remote but requires a Compact State Nursing License and… more
- Actalent (Orlando, FL)
- Clinical Review Nurse - Concurrent Review Location: Remote - Candidates can be live anywhere in the US but must be able to work CST hours Schedules ... 6:30 PM CST Position Overview We are seeking Clinical Review Nurses to join our remote team....remote team. In this role, you will perform concurrent reviews to evaluate medical necessity, determine appropriate levels… more
- Centene Corporation (Columbus, OH)
- …, InterQual knowledge, and discharge planning.** **Additional Details:** Department: Concurrent Review MCD** Business Unit: Corporate** Schedule: Monday-Friday ... perspective on workplace flexibility. NOTE: This is a fully remote role. Preference will be given to applicants (1)...member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a CDI Concurrent Review and Query Specialist? At HCA Healthcare, you come first. HCA Healthcare ... **Description** This is a fully remote role but you must live within 60...a difference. We are looking for a dedicated CDI Concurrent Review and Query Specialist like you… more
- Centene Corporation (Jefferson City, MO)
- …providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically appropriate determinations + ... on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review and assessment of complex services previously provided to determine… more
- Centene Corporation (Jefferson City, MO)
- …providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically appropriate determinations + ... perspective on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review of services previously provided to determine if the level of… more
- Henry Ford Health System (Warren, MI)
- …and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous ... and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical experience required. +… more
- CVS Health (Lansing, MI)
- …clinical criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review . + Conduct clinical reviews via phone and ... in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and clinical… more
- Actalent (Sacramento, CA)
- …Certified Case Manager (CCM), CPUR, or CPHM credential preferred. + Background in concurrent review or inpatient census oversight preferred. + Strong critical ... Remote Licensed Vocational Nurse (LVN) Fully...Conduct in-person hospital rounds 2-3 days per week, telephonic review and participate in interdisciplinary case reviews + Escalate… more
- Providence (Beaverton, OR)
- …Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review , Prior Authorization, Medical Audits, Appeals or ... nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing...care to our members **Providence Health Plan welcomes 100% remote work to residents who reside in the following… more
- Trinity Health (Livonia, MI)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Purpose** Work Remote Position (Pay Range: $24.5303-$36.7954) Provides oversight & support of ... services. Responsible for charge capture in Revenue Integrity assigned areas. Review 's chart, including nursing notes, physician orders, progress notes, and surgical… more
- Vitalief (Philadelphia, PA)
- …and grow sustainably. The Role We are seeking an experienced Clinical Research Nurse to join our exceptional team as a full-time Vitalief employee. In this ... plans. + Hybrid schedule : 4 days on-site (Philadelphia), 1 day remote weekly. + Market-competitive salary , commensurate with experience. Responsibilities: + Under… 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 ... PA, but may allow for some days to be remote in the future. The role is full-time, 40...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** **This position is remote . Candidates must be local to New England States for consideration** The Clinical ... Documentation Improvement (CDI) Specialist Registered Nurse (RN) assists with the appropriate identification of diagnoses, conditions, and/or procedures that are… more
- Trinity Health (Livonia, MI)
- …Type:** Full time **Shift:** Day Shift **Description:** **POSITION PURPOSE** Work Remote Position Utilizes advanced clinical and coding expertise to direct efforts ... accuracy and integrity of medical record documentation through extensive record review . Through extensive interaction with physicians and other members of the… more
- International Medical Group (Indianapolis, IN)
- …an active RN license in good standing in Indiana. + Location: Hybrid or Remote working options. + Corporate office is in Indianapolis, IN. + Relocation Expenses ... of the use of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between the Insured, the… more
- CareFirst (Baltimore, MD)
- …**PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective ... Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, mandates, medical… more
- BrightSpring Health Services (Mount Laurel, NJ)
- …Registered Professional Nurse + Excellent communicator with ability to handle concurrent tasks and responsibilities + Ability to travel within assigned area + ... of health care within all programs. + Travels to programs to review individual records, collaborate with para-professional team members, and evaluate nursing… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization review plans… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review - Remote . This position will work full- time in a 8-hr Day shift.** Provide prospective, retrospective, and concurrent ... reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all payers,...Qualifications:** + Associate's Degree in Nursing. + California Registered Nurse License upon hire. + 2 years of experience… more