- Centene Corporation (Cheyenne, WY)
- …based on diagnoses, prognoses, resources, and/or preferences + Manages 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 + Provides education to providers on… more
- Molina Healthcare (CA)
- …seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge of ... **JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSE ** **For this...to work some weekends and holidays. This is a remote position and you may work from home. Please… more
- Veterans Affairs, Veterans Health Administration (Beckley, WV)
- …after complete review of the EDRP application. Responsibilities The Registered Nurse - Community Living Center (CLC) Nurse Manager executes position ... systematic data collection, aggregation, analysis, and reporting techniques to achieve concurrent compliance review of identified quality/patient safety metrics.… more
- HCA Healthcare (Corpus Christi, TX)
- …Medical Center Bay Area!** **Job Summary and Qualifications** **The Quality Review Nurse position encompasses multiple responsibilities including Core Measure ... chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews...path, we encourage you to apply for our Registered Nurse Clinical Reviewer PRN opening. We review … more
- HCA Healthcare (Corpus Christi, TX)
- …Christi Medical Center Bay Area! **Job Summary and Qualifications** The Review Nurse Clinical Reviewer position encompasses multiple responsibilities including ... Core Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews & is proactive in working with departments on… more
- HCA Healthcare (Houston, TX)
- …HCA Houston Healthcare Northwest!** **Job Summary and Qualifications** **The Quality Review Nurse position encompasses multiple responsibilities including Core ... **Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your current role?...Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews… more
- HCA Healthcare (Mcallen, TX)
- …benefits may vary by location._ **Job Summary and Qualifications** The Review Nurse Clinical Reviewer position encompasses multiple responsibilities including ... about delivering patient-centered care? Submit your application for Registered Nurse Quality position and spend more time at the...Core Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews… more
- HCA Healthcare (Kingwood, TX)
- …HCA Houston Healthcare Kingwood!** **Job Summary and Qualifications** **The Quality Review Nurse position encompasses multiple responsibilities including Core ... **Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your current role?...Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews… more
- Humana (Montgomery, AL)
- …case management referrals and any other specific market initiatives. + Performing concurrent review and/or discharge planning for all Humana Medicare/Medicaid ... and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the...Hours are Monday-Friday 8am-5pm EST/CST + This is a remote position **Scheduled Weekly Hours** 40 **Pay Range** The… more
- AmeriHealth Caritas (Newark, DE)
- …changes. + Have working knowledge of prior authorization, medical necessity determinations, concurrent review , retrospective review , continuity of care, care ... **Utilization Management Plan Oversight Manager, Registered Nurse (must reside in DE)** Location: Newark, DE...business. This position will solicit ideas for systems improvements, review and present new system enhancements/features, and engage in… more
- Albany Medical Center (Albany, NY)
- …financial constraints. c. Provides collaborative care management with the primary nurse in assessing for discharge planning needs, coordinating appropriate resources ... in the referral process and use of community resources. 2. Utilization Review a. Reviews data from admission screening to clarify admission diagnosis, establish… more
- CVS Health (Phoenix, AZ)
- …information from providers. Required Qualifications + 1+ year: Oncology and Transplant UM, concurrent review or prior authorization + 3+ years: acute clinical ... care more personal, convenient and affordable. Position Summary 100% remote position from anywhere in the US Work hours:...100% participation during 8:30am-5pm Monday-Friday EST. + A Registered Nurse that must hold an unrestricted license in their… more
- Geisinger (Wilkes-Barre, 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 ... mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of...certification is preferred. Note: this position is not a remote position Geisinger cares about not only its patients… more
- CVS Health (Baton Rouge, LA)
- …+ 5+ years of clinical experience + 1+ year(s) of utilization management, concurrent review and/or prior authorization experience + 5+ years of equipment ... care more personal, convenient and affordable. Position Summary Fully remote role in Louisiana.Requires Monday-Friday: 8:00am-5:00pm CST shift. Weekend/holiday… more
- International Medical Group (Indianapolis, IN)
- …an active RN license in good standing in Indiana. + Location: Hybrid or Remote working options. + Corporate office is in Indianapolis, IN. + Relocation Expenses ... of the use of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between the Insured, the… more
- University of Miami (Hialeah, FL)
- …staff as the key resource for clinical documentation and coding. + Maintain concurrent and retrospective review expertise to ensure accuracy, specificity, and ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Manger of… more
- AdventHealth (Altamonte Springs, FL)
- …are even better. **Shift** : Full-time; Monday - Friday **Job Location** : Remote **The role you'll contribute:** Under general supervision of the Director of ... in the management of resources entrusted to them. . Reviews concurrent medical record for documentation compliance including completeness and accuracy for… more
- Actalent (Sacramento, CA)
- …30 days or 72 hours if the request is deemed expedited. Skills: + Acute care + Concurrent review + Home health + Health plan + Utilization review + ... this role, you will perform accurate and timely clinical review of Member-initiated appeals. + The RNs perform first...Required: Windows suite of applications. Work Environment: + Tele remote + Monday through Friday (day shift) - 8am… more
- Access Dubuque (Dubuque, IA)
- Clinical Document Specialist - CDI - Remote **MercyOne** 1 Positions ID: TRHEUS00496408MERCYO Posted On 05/17/2024 **Job Overview** **Employment Type:** Full time ... Shift **Description:** Preferred certification or licensure includes: Current Registered Nurse License, Registered Health Information Administrator (RHIA), Registered Health… more
- Providence (Vancouver, WA)
- …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...and quality care to our members **Providence welcomes 100% remote work to residents who have a current home… more
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