- Actalent (Tigard, OR)
- Job Title: Clinical Review Nurse - Concurrent Review Work Environment + This is a 100% remote position + The schedule is Tuesday to Saturday, 10 AM ... concurrent review . Job Description The Clinical Review Nurse will perform concurrent ...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
- Actalent (Bakersfield, CA)
- Remote Concurrent Review Nurse Job Description We are seeking a dedicated Concurrent Review Nurse to perform concurrent reviews, assess ... diagnoses, prognoses, resources, and/or preferences + Manages and maintains concurrent review findings, discharge plans, and actions...attire suitable for a clinical setting. Job Type 100% Remote ! Pay and Benefits The pay range for this… more
- Centene Corporation (Sacramento, CA)
- …hold a current CA license **Must have** **5-7 years related** **experience in UM- Concurrent Review . 2+ years of acute care experience required. 10% Travel ... based on diagnoses, prognoses, resources, and/or preferences + Manages and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Actalent (Tigard, OR)
- Job Title: Clinical Review Nurse - Concurrent Review (West Coast) Job Description We are seeking a dedicated Clinical Review Nurse to perform ... necessity and appropriate setting. + Prepare denial letters for concurrent review without member or provider outreach....utilization management processes. Work Environment This is a 100% remote position based on the West Coast, with working… more
- Centene Corporation (Sacramento, CA)
- …hold a current CA license.** **Must have** **2-4 years related** **experience in UM- Concurrent Review . 2+ years of acute care experience required. 10% Travel ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- CVS Health (Carson City, NV)
- …in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and clinical ... members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team....Management (UM) Nurse Consultant to join our remote team. **Key Responsibilities** + Apply critical thinking and… more
- CVS Health (Phoenix, AZ)
- …+ Minimum of 1 year of experience in Oncology and Transplant either in UM, concurrent review , or prior authorization + 3+ years of experience in Acute clinical ... in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position… more
- CVS Health (Santa Fe, NM)
- …outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and ... members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role, you'll be at the forefront of… 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
- BrightSpring Health Services (Fort Wayne, IN)
- …Registered Professional Nurse + Excellent communicator with ability to handle concurrent tasks and responsibilities + Ability to travel within assigned area + ... meetings + Chairing committees as appropriate, safety, infection control, incident review , and human rights committees + Facilitating communication and serving as… more
- Providence (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
- GE Vernova (Wilmington, NC)
- …change control, and configuration management. + Perform design technical oversight, review , and verification of deliverables to ensure their adequacy in; accuracy, ... contact for Regulatory Affairs or Licensing for preparation or review and comment of; Preliminary Safety Analysis Report (PSAR),...Headquarters in Wilmington, NC; but highly qualified (US based) remote candidates will be considered. + This role is… more
- Virtua Health (Pennsauken, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... of Philadelphia for pediatrics. Location: Pennsauken - 6991 North Park Dr. Remote Type: On-Site Employment Type: Employee Employment Classification: Per Diem Time… more
- Sharp HealthCare (San Diego, CA)
- …**Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Case Manager (CCM) - ... requires the ability to combine clinical/quality considerations with regulatory/financial/utilization review demands to assure patients are receiving care in the… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- **Responsibilities** **JOB SUMMARY / PURPOSE** **This will be a remote position.** Responsible for the review of medical records for appropriate admission status ... Coordination staff utilizing evidence-based guidelines and critical thinking. Collaborates with the Concurrent Denial RNs to determine the root cause of denials and… more
- Magellan Health Services (San Diego, CA)
- …person-centered care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care ... Job Information Title Care Manager, Health Plan, Part Time, Licensed/ Remote in CA Grade 25 Work Experience - Required...Licensed Professional Counselor - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt… more
- Northwell Health (Melville, NY)
- …care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. Performs concurrent and retrospective utilization ... of illness and intensity of services provided. Performs PRI's (Patient Review Instrument), as needed. Performs related duties as required. All responsibilities… more
- Centene Corporation (Phoenix, AZ)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... benefits including a fresh perspective on workplace flexibility. **Location: Position is remote . Candidate will work PST hours.** Must be licensed in TX and/or… more
- Vanderbilt University Medical Center (Nashville, TN)
- …procedures independently. Documents the patient's clinical status and care provided. Performs concurrent review of patient records for documentation to support ... of emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC-Registered Nurse - Licensure-Others **Work Experience:** Relevant Work Experience **Experience… more
- Centene Corporation (Columbus, OH)
- …PEOPLE LEADER EXPERIENCE STRONGLY PREFERRED **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