- Centene Corporation (New York, NY)
- …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
- 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 ... Days, Evenings, Nights available* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within… more
- Northwell Health (Sleepy Hollow, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. ... collaboration with the health care team. + Conducts chart review for appropriateness of admission and continued length of...and continued length of stay; Facilitates throughput. + Conducts clinical reviews and interacts with third party payers to… more
- Mount Sinai Health System (New York, NY)
- …preferred. + Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign ... 4. Conducts Root Cause Analysis investigations which include assessing need for focused review by departments, and/or clinical chairpersons for peer reviews. 5.… more
- Centene Corporation (New York, NY)
- …be working with our Children member's - ages 0-18.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance ... medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine… more
- Nuvance Health (Danbury, CT)
- …care. Develop clinical criteria and guidelines for efficient UR processes. * * Concurrent Review :* Oversee the concurrent review process, monitoring ... leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical ...nurse (RN) * Minimum of 5 years of clinical experience in an acute care setting * Minimum… more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. c. Provides clinical information requested by the ... for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).… more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. 13. Provides clinical information requested by the ... for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).… more
- Centene Corporation (New York, NY)
- …Utilization Management** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... between utilization management team, members, and providers + Monitors prior authorization, concurrent review , and/or retrospective clinical review … more
- Molina Healthcare (Yonkers, NY)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the… more
- MVP Health Care (Tarrytown, NY)
- …the Medical Director to ensure appropriate outcomes. + Service Authorization & Review : Conduct prospective, concurrent , and retrospective reviews to determine ... + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within...after hire. + At least 3 years of recent clinical and Case Management experience. Experience working in a… more
- Molina Healthcare (Yonkers, NY)
- …requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care ... for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation… more
- Nuvance Health (Norwalk, CT)
- …are executed to the appropriate level within the care continuum. Provides clinically based concurrent review of the medical record to assess and procure accurate ... *Description* * Clinical Care Coordinator/RN Case Manager - Per Diem...between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate status is… more
- MVP Health Care (Tarrytown, NY)
- …and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required + New York State license required + Licensed Behavior ... or Board-Certified Behavior Analyst (BCBA) preferred. If possessing an LBA, another clinical license is not required. + Willingness and ability to obtain equivalent… more