- Centene Corporation (Columbus, OH)
- …, InterQual knowledge, and discharge planning.** **Additional Details:** Department: Concurrent Review MCD** Business Unit: Corporate** Schedule:** ... 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
- 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 ... **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
- 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
- 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 ... Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Nov 5,… more
- AdventHealth (Orlando, FL)
- …All while understanding that **together** we are even better. **Schedule:** Full Time Remote , Applicant must live within a 50-mile radius or be a current employee ... **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to… 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 (Phoenix, AZ)
- …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
- CVS Health (Salt Lake City, UT)
- …clinical criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review . + Conduct clinical reviews via phone and ... members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team....At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong… 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
- 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
- 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
- Centene Corporation (San Diego, CA)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... Remote - TX** **Position Purpose:** Performs a clinical review and assesses care related to mental health and...+ Experience working with providers and healthcare teams to review care services, precertification, concurrent review… 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 (Athens, GA)
- …accuracy and integrity of medical record documentation through extensive record review . Through extensive interaction with physicians and other members of the ... provider engagement. Identifies learning opportunities for healthcare providers. Conducts concurrent reviews of selected patient health records to address… more
- Centene Corporation (Honolulu, HI)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... organization offering competitive benefits including a fresh perspective on workplace flexibility. Remote Position. Must Reside in Hawaii Registered Nurse (RN)… 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
- 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
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Full- time and will work 8-hour, Day shifts.** ... of US hospitals are four times designated. Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and… more