- Geisinger (Scranton, PA)
- Job Title: RN - Registered Nurse Care Manager Location: Scranton, Pennsylvania Job Category: RN - Registered Nurse , Nursing and Nursing Support Schedule: Days ... Top 8 Most Innovative Healthcare Systems in Becker's Hospital Review , we're working to create a national model for...avoid third party payer denials. Maintains awareness of all concurrent denials through interaction with payer liaison. Works with… more
- Alameda Health System (San Leandro, CA)
- …utilization review functions, including response to payor requests for concurrent and retrospective review information including Medicare and MediCal ... Nurse , Care Management + San Leandro, CA +...physician, and the Care Management physician advisor of any concurrent denials.Prepares case reports;documents treatment plan, progress notes and… more
- Providence Little Company of Mary Medical Center - San Pedro (San Pedro, CA)
- …perform discharge planning and utilize interqual criteria - Experience in utilization review and concurrent reviews Description: This position requires rotating ... Specialty Case Manager Job ID 33531206 Job Title Registered Nurse - Case Manager @ Providence Little Company of...Week(s) Job Description Job Title: Case Manager Profession: Registered Nurse Specialty: Case Management Duration: 13 weeks Shift: Day… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …do:** + Performs medical necessity review that includes inpatient review , concurrent review , benefit advisory/prior authorization, retrospective, out ... . The **Care Coordinator** - **Clinical Appeals** performs prospective review (benefit advisory/ prior authorization) admission, concurrent , and… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …do:** + Performs medical necessity review that includes inpatient review , concurrent review , benefits advisory/prior authorization, retrospective, out ... **Care Coordinator - Inpatient RN** performs reviews of admissions and concurrent stay requests for acute hospitalizations, skilled nursing, and inpatient… more
- Commonwealth Care Alliance (Boston, MA)
- …for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting centralized clinical ... reviews). - Hire, train and mentor UM staff, including nurse reviewers and support personnel. - Act as liaison...& Abilities (must have): - Expertise in managing utilization review processes including prior authorization, concurrent and… more
- Stanford Health Care (Palo Alto, CA)
- …include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness ... ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements. Case Managers act as consultants to the clinical… more
- Jobleads-US (Saddle Brook, NJ)
- …knowledge of workers' compensation policy and manage incidents, and dispatch nurse case managers as necessary. Collaborate closely with Risk Management leadership ... and pursued and manage lien recovery on case-by-case basis. Participate in claims review process and monitor claims handling process by carriers and TPAs; provide… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …+ Assess discharge planning needs at the patient's admission + Perform regular concurrent review on all patients and coordinate all needed services including ... and acquire authorizations for treatment **Key Qualifications:** + Current NYS Registered Nurse License/Registration and BSN preferred + At least 2-3 years of… more
- Centene Corporation (Columbus, OH)
- …, InterQual knowledge, and discharge planning.** **Additional Details:** Department: Concurrent Review MCD** Business Unit: Corporate** Schedule:** ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Centene Corporation (Baton Rouge, LA)
- …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
- 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
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt of high ... medical services, notification of emergent hospital admissions, completes inpatient concurrent review , establishes discharge plans, coordinates transitions of… 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
- 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
- YesCare Corp (Brentwood, TN)
- …+ Assist in the control of utilization of resources, pre-occurrence monitoring, concurrent monitoring, intervention and retrospective review . + Track, trend and ... that is transforming lives through care and expertise. **Key Responsibilities:** + The nurse will focus on what's best for the patients within assigned contracts and… more
- Avera (Sioux Falls, SD)
- …Utilizes third party clinical guidelines for level of care reviews (first level review ), and refers cases to the internal or external physician advisor for ... payer for level of care requirements, inpatient only list, concurrent and retrospective authorization requirements, documentation requirements, non-covered services,… 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
- 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
- Actalent (Phenix City, AL)
- Urgent Hiring for "Remote Clinical Review RN" Job Description: + Perform concurrent reviews to assess member's overall health. + Review the type of care ... being delivered and evaluate medical necessity. + Contribute to discharge planning according to established care policies and guidelines. + Assist in evaluating inpatient services to ensure the necessity and appropriate setting of care. Qualifications: + 2+… more
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