- Centene Corporation (Springfield, IL)
- …InterQual knowledge, and discharge planning knowledge. **Additional Details:** Department: Concurrent Review MCD** Business Unit: Corporate** Schedule: Mon-Fri ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Cognizant (Springfield, IL)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical … more
- CVS Health (Springfield, IL)
- …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. **Key Responsibilities**...At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong… 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 ... accredited school of nursing and a current state Registered Nurse license 2. Grandfathered prior to April 1, 2015....of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred. 3.… more
- Centene Corporation (Springfield, IL)
- …with 1 hour lunch; plus weekend and holiday rotations **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
- Carle Health (Champaign, IL)
- …Work Experience: Clinical bedside; CDI Responsibilities Conducts the initial concurrent review process for all selected admissions. Clarifies documentation ... Overview Performs inpatient chart review to determine appropriate DRG assignment and assures...and assures appropriate documentation in the chart to support clinical care provided, including severity of illness and risk… more
- Carle Health (Urbana, IL)
- …and changes related to coding. + Ensures proper coordination between Concurrent Clinical Documentation Specialists, inpatient coders, outpatient coders, ... (COC) or + Certified Inpatient Coder (CIC) or + Licensed Registered Professional Nurse (RN) or + Certified Coding Specialist - Physician-Based (CCS-P) or +… 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 ... accredited school of nursing and a current state Registered Nurse license 2. Grandfathered prior to April 1, 2015....of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred. 3.… more
- Prime Healthcare (Evanston, IL)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... accredited school of nursing and a current state Registered Nurse license 2. Grandfathered prior to April 1, 2015....of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred. 3.… more