- 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
- Cognizant (Trenton, NJ)
- …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
- Prime Healthcare (Bristol, PA)
- …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 + Grandfathered prior to April 1, 2015....of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred. +… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Clinical Program Manager for Geriatrics and Palliative Medicine supports the Vice Chair of Quality and Clinical Information and oversees ... as a component within the department or larger health system. The Clinical Program Manager leads quality and performance improvement programs in collaboration with… 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
- Vitalief (New Brunswick, NJ)
- …in New Brunswick, NJ. Job Responsibilities: + Under the direct supervision of the Nurse Manager of Clinical Research Center (CRC), you will be responsible for ... of Sites, Sponsors, and CROs across the research and clinical trials landscape. By blending deep subject matter expertise...plus. + Ability to work on 12 to 15 concurrent trials - must have strong organizational and prioritization… more
- Hackensack Meridian Health (Neptune City, NJ)
- …experience. **Licenses and Certifications Required:** + Current state Registered Nurse license. + Certified Clinical Documentation Specialist (CCDS) ... healthcare and serve as a leader of positive change. The ** Clinical Documentation Specialist RN** facilitates improvement in the overall quality, completeness… 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
- 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
- Northwell Health (Staten Island, NY)
- …Patients Discharge Instruction Sheet and the Patient Transfer Sheet. + Ensures Patient Review Instrument (PRI) is completed and reflects clinical profile of the ... clinical pathways, variance analysis and trending, quality management/utilization review and home care/discharge planning, preferred. + Keeps abreast of… more