- Bluestone Child & Adolescent Psychiatric Hospital (University Heights, OH)
- …skills. Experience: A minimum of 1 year experience as a psychiatric nurse . 1-2 years-experience in behavioral health utilization review preferred. AGENCY ... Psychiatric Intake Nurse - FT Nights, 5-8 hour shifts- Sunday through...to all Bluestone Intak email, faxes and phone calls. Review all referrals for clinical appropriateness within 10 minutes… more
- Christus Health (Alexandria, LA)
- …in their resolution. * Coordinates with quality department by: providing concurrent review for core measures documentation, providing retrospective chart ... and experience, apply today. Summary: The Clinical Documentation Registered Nurse collaborates extensively with physicians, nursing staff, other patient caregivers… more
- MVP Health Care (Rochester, NY)
- …. The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This individual ... licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required New York State license required Licensed Behavior Analyst (LBA)… more
- MVP Health Care (Tarrytown, NY)
- …with the Medical Director to ensure appropriate outcomes. Service Authorization & Review : Conduct prospective, concurrent , and retrospective reviews to determine ... Qualifications you'll bring: Current New York State Licensure as a Registered Nurse required. Certification in Case Management required within 24 months after hire.… more
- Actalent (Austin, TX)
- Clinical Review Nurse - Concurrent Review Location: Remote - Compact Nursing License required; must be able to work CST hours Schedule: Tuesday-Friday, ... basis Business Unit: Medicaid About the Role We are seeking a Clinical Review Nurse to perform concurrent reviews for Medicaid members, ensuring appropriate… 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. In this...our 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 ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Trinity Health (Syracuse, NY)
- …administrative requirements for Utilization Management and works collaboratively with Utilization Management/ Concurrent Review Nurse , physicians, staff and ... possible concurrent denials, forwards information to the appropriate Utilization Management/ Concurrent Review Nurse within identified process standards *… 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 ... a difference. We are looking for a dedicated CDI Concurrent Review and Query Specialist like you...care facility required Licenses, Certifications, & Training: + Registered Nurse - Currently licensed as a Registered Professional … more
- Houston Methodist (Houston, TX)
- … functions through point of entry, observation progression of care management, concurrent review and denials reviews. Additionally, the URSN will prospectively ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is... (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- …on Service Connection (SC), non-SC, Special Authority (SA), precertification, prospective review , concurrent review , denial management, retrospective ... Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the… more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality/Utilization Review Nurse Position Summary: The Quality/Utilization Review Nurse is responsible for evaluating the medical necessity, ... infection prevention protocols and regulatory compliance. Key Responsibilities: * Utilization Review : o Conduct concurrent and retrospective reviews of patient… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... 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
- UNC Health Care (Kinston, NC)
- …the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria ... of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service,...3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review ,… more
- Dignity Health (Gilbert, AZ)
- …the general direction of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the ... Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… 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
- 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 ... cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by nursing judgment and/or...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Ventura County (Ventura, CA)
- …and patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review , case management, ... may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent , retrospective, out of network and medical… more
- Beth Israel Lahey Health (Cambridge, MA)
- …reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...to collect data for reporting quality measures, including both concurrent medical record review and periodic medical… more
