- 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
- 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
- Prime Healthcare (Mount Prospect, IL)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... post-graduation of an accredited school of nursing and a current state Registered Nurse license 2. Grandfathered prior to April 1, 2015. Minimum 5 years post… more
- Veterans Affairs, Veterans Health Administration (Lebanon, PA)
- …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...Nurse III; OR a Master's degree in *related field with BSN and two years of specialized nursing… more
- Sacramento County (Sacramento, CA)
- Nurse Practitioner Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1780920) Apply Nurse Practitioner Salary $132,483.60 - $161,026.56 ... 9/26/2025, 10/24/2025, 11/26/25, 12/26/25, 1/23/26, 2/27/26, 3/27/26, 4/24/26, 5/22/26, 6/26/26 Nurse Practitioners provide a range of health care services involving… more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse D/CF Salary ... on: 12/1/25, 2/2/26, 4/6/26, 6/1/26, 8/3/26, 10/5/26, 12/7/26 Supervising Registered Nurse - Detention/Correctional Facility is the first level supervisory class in… more
- Sacramento County (Sacramento, CA)
- Supervising Public Health Nurse Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/600083) Apply Supervising Public Health Nurse Salary ... the operations, program, and personnel of a public health field office staffed by professional nurses, health workers and...One year of experience as a Senior Public Health Nurse in Sacramento County service. Or: Two years of… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse (RN) - Case Manager - 2506003285 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with ... a) accurate medical necessity screening and submission for Physician Advisor review , b) care coordination, c) transition planning assessment and reassessment, d)… 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 ... will support the planning, implementation, and execution of multiple concurrent clinical research studies, including NIH-sponsored, industry-sponsored, and investigator-initiated… more
- HonorHealth (AZ)
- …transition to next level of case management or care coordination services. Performs concurrent review of patient treatment plans in accordance with the hospital ... maintenance of department logs and databases, department statistics, and utilization review documents according to hospital policy and state/ federal regulations. +… 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 + ... adults with intellectual and developmental disabilities. + Supervises a team of field -based travel nurses (LPNs) in the performance of clinical duties. + Provides… more
- Centene Corporation (San Diego, CA)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... of an Accredited Master's degree - Behavioral Health related field is preferred + Master's degree AND 2 -...+ Experience working with providers and healthcare teams to review care services, precertification, concurrent review… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work onsite. ... *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include supervising staff… more
- Centene Corporation (Honolulu, HI)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... perspective on workplace flexibility. Remote Position. Must Reside in Hawaii Registered Nurse (RN) or Licensed Clinician Only. Must have a current state's license… more
- Nuvance Health (Danbury, CT)
- …payers. * If concurrent inpatient case does not meet medical necessity review criteria during the first level review , discuss with the attending MD ... REQUIRED* * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within… more
- Nuvance Health (Danbury, CT)
- …level of care. Develop clinical criteria and guidelines for efficient UR processes. * * Concurrent Review :* Oversee the concurrent review process, ... leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff...field preferred * Current licensure as a registered nurse (RN) * Minimum of 5 years of clinical… more
- Centene Corporation (Sacramento, CA)
- …a fresh perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical ... between utilization management team, members, and providers + Monitors prior authorization, concurrent review , and/or retrospective clinical review nurses… more
- Sacramento County (Sacramento, CA)
- …Licensed Clinical Social Worker, Marriage and Family Therapist, or Registered Nurse . AND Either: Two years of experience coordinating and/or supervising mental ... Two years of experience in the class of Mental Health Counselor, Psychiatric Nurse , Senior Mental Health Counselor, Senior Psychiatric Nurse , or Supervising… more
- Penn Medicine (Lancaster, PA)
- …to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means ... to 12 months** **Summary:** + Position Summary: Responsible for complete and accurate review of all trauma patient records, collecting data for the PA Trauma Systems… more
