- GIBSON AREA HOSPITAL (Gibson City, IL)
- …Time Salary Range $32.00 - $48.00 Hourly Description JOB TITLE: UTILIZATION REVIEW /CASE MANAGEMENT - Nurse DEPARTMENT: CASE MANAGEMENT (QUALITY) GENERAL SUMMARY ... The Utilization Review /Case Management ...interact with patients/families, healthcare providers, and outside agencies. Registered Nurse with at least two years clinical … more
- Prime Healthcare Hospice and Palliative Care (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
- HireMaster (Lincoln, NE)
- …duties are also required in the department noted above. Performs utilization review activities, including concurrent and retrospective reviews as required. ... SUMMARY: The Care Transitions RN conducts day-to-day activities for the clinical , psychosocial and utilization coordination of the patients hospital experience.… more
- Centene Corporation (Richmond, VA)
- …- 5pm Eastern with some holidays on a rotating basis.** + **Previous concurrent review experience is highly preferred.** **Position Purpose:** Performs ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring the ... receives and reviews notification of emergent hospital admissions, completes inpatient concurrent review , establishes discharge plans, coordinates transitions of… more
- AdventHealth (Celebration, FL)
- …in the defeat of illness and disease **The role you'll contribute:** The Clinical Nurse Education Facilitator (CNEF) is an expert clinician, highly skilled ... thinking, critical reflection, and life-long learning to adapt quickly to changing clinical environments and escalating patient care needs. The CNEF will use a… more
- Vitalief (Philadelphia, PA)
- …role will support the planning, implementation, and execution of multiple concurrent clinical research studies, including NIH-sponsored, industry-sponsored, and ... operate more efficiently and grow sustainably. The Role We are seeking an experienced Clinical Research Nurse to join our exceptional team as a full-time… more
- Geisinger (Danville, 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 ... work on site position located in Danville, Pennsylvania. The Clinical Documentation Improvement Program (CDI) is designed to improve...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- Blue KC (Workman, MN)
- …authorization letters, and follows in FACETS UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside medical ... case management and clinical transplant experience + Valid and active Registered nurse (RN) licensure in all 50 states and the District of Columbia initiated… more
- Beth Israel Lahey Health (Boston, MA)
- …being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for ... a Registered Nurse (RN), Massachusetts + Three years of recent clinical or utilization management experience _Preferred:_ + Bachelor's degree in nursing or… more
- Ansible Government Solutions (Memphis, TN)
- …success as if it is their own. Responsibilities + Act as the Registered Nurse Advisor for the facility's CDI program, focusing on both inpatient and outpatient ... services + Review health records concurrently to identify opportunities for improved...identify opportunities for improved documentation and coding accuracy using clinical knowledge and critical thinking skills + Support CDI… more
- CDPHP (Latham, NY)
- …The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes ... exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care… more
- University of Utah Health (Salt Lake City, UT)
- …and continued stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient ... expected cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests for ... in utilization management, behavioral health, and mental health. + Proficiency in clinical and utilization review processes. + Current unrestricted Florida RN… more
- Dayton Children's Hospital (Dayton, OH)
- …concurrent and retrospective denials. The Physician Advisor role will support the Utilization Review RN for second level clinical reviews for cases that do ... Facility:Dayton Children's - Main CampusDepartment:Utilization Review TeamSchedule:Full timeHours:40Job Details:Under the supervision of the Manager of Utilization… more
- UNC Health Care (Kinston, NC)
- …assures timely movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of ... the right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care,… more
- Beth Israel Lahey Health (Plymouth, MA)
- …data to establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal ... the care provided to the hospitalized patient. + Conducts concurrent reviews to determine the continued need for acute...degree in healthcare preferred. + Three years recent, broad clinical experience in the hospital setting + Experience with… more
- Beth Israel Lahey Health (Cambridge, MA)
- …reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret data, and implement ... + Reviews medical records to collect data for reporting quality measures, including both concurrent medical record review and periodic medical record review … more
- Baystate Health (Springfield, MA)
- …growth, role competence and proficiency in their specialty.** + The Nurse Educator facilitates the achievement of professional/ clinical outcomes with ... BH model of patient care. + In collaboration with clinical managers and quality leaders, the Nurse ...of Nursing Professional Development and encourages the advancement of clinical nursing practice and professional development through review… more
- UHS (Johnson City, NY)
- …registry by working closely with the TPM and Trauma Registrars to assure accurate, concurrent clinical data abstraction and entry into the trauma registry. The ... Position OverviewThe Trauma Resource Nurse (TRN) has responsibility for concurrent ...to assure the provision of safe, efficient and effective clinical care to all injured patient by continuously monitoring,… more
