- Centene Corporation (Columbus, OH)
- …, InterQual knowledge, and discharge planning.** **Additional Details:** Department: Concurrent Review MCD** Business Unit: Corporate** Schedule:** ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Trinity Health (Westerville, OH)
- …going above and beyond to provide the highest standards of care. The Clinical Documentation Specialists will concurrently review medical records and assist ... physicians in removing the barriers between clinical and coding languages to allow more specific and...model of the ANCC Magnet Recognition Program(R). + Conducts concurrent reviews of selected patient records to address legibility,… more
- Banner Health (OH)
- …thoroughly completes documentation required for claims payment of services approved through concurrent review 2. Supervises the team to ensure internal/external ... clinical denials. Collaborates with Care Coordination, physician, Utilization Review , and other internal/external departments to overturn and/or reduction of… more
- Molina Healthcare (Akron, OH)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in… more
- Molina Healthcare (Dayton, OH)
- …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
- Molina Healthcare (Columbus, OH)
- …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
- Elevance Health (Mason, OH)
- … clinical staff. + Conducts and may approve pre-certification, concurrent , retrospective, out of network and/or appropriateness of treatment setting reviews ... not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians....equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. +… more
- Prime Healthcare (East Liverpool, OH)
- …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