- Centene Corporation (Little Rock, AR)
- …offering competitive benefits including a fresh perspective on workplace flexibility. Clinical Review Nurse - Concurrent Review & Outpatient Services ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- CVS Health (Annapolis, MD)
- …required with ability to obtain additional licenses as needed. + Utilizes clinical skills to coordinate, document and communicate all aspects of the ... and administration of the utilization/benefit management function + Gathers clinical information and applies the appropriate medical necessity criteria/guideline,… more
- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + ... Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse...Patient care + Medical record + Case management + Concurrent review + Discharge planning + Medical… more
- Children's Mercy Kansas City (Kansas City, MO)
- …can improve the lives of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, ... authorization per contracts for medically appropriate level of care. Manages concurrent clinical denials through completion of verbal reconsideration process.… more
- Northwell Health (Lake Success, NY)
- … clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests clarification ... of clinical documentation from the physician(s) on a ...date. *Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications… more
- Dignity Health (Carmichael, CA)
- **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite Campus Position** The **Utilization Review RN** is responsible for the ... Utilization Review product(s) used + Proficient in application of clinical guidelines (MCG/InterQual) preferred + Knowledge of managed care and payer environment… more
- LifePoint Health (Hickory, NC)
- *Registered Nurse (RN), Clinical Case Manager* PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment to ... to care. * Coordinates changes to the care plan as needed. *6. Utilization Review & Documentation** Performs admission and concurrent medical record reviews. *… 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 ... Job Summary The Clinical Documentation Improvement Program (CDI) is designed to...Dayshift; Monday through Friday. Candidates must hold a Registered Nurse license in Pennsylvania or a Multistate License. A… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity...regarding any claim issues or concerns that may require clinical review during the pre-bill, audit, or… more
- CDPHP (Albany, 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
- 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
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition ... (inpt vs OBS). Facilitates concurrent reviews and authorizations for admissions. This position will...programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. +… 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
- 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
- Lompoc Valley Medical Center (Lompoc, CA)
- …the monitoring and evaluation of processes for clinical performance improvement and peer review . The QA nurse supports concurrent oversight and review ... quality department management in the implementation and monitoring of the Hospitals' clinical quality improvement efforts. This may include concurrent oversight… more
- LA Care Health Plan (Los Angeles, CA)
- …in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff, physicians, providers, ... Utilization Management Nurse Specialist RN II Job Category: Clinical...productive workplace environment. Perform telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff,… 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
- NJM Insurance (Parsippany, NJ)
- … clinical information and updates needed to effectively and accurately perform concurrent review . + Identify medical and community needs and facilitate/assist ... uphold, modify, or overturn prior decisions. + Conduct Inpatient Care utilization review using NJM and evidence-based clinical guidelines to ensure appropriate… more
- AdventHealth (Riverview, FL)
- …appropriate leaders for analysis and corrective action to improve quality outcomes. Assures concurrent review is performed on those patients that may trigger ... styles. Assess organizational status in relation to assigned core measure(s) Performs concurrent data review and rounding for assigned patients within designated… more
- AdventHealth (Glendale Heights, IL)
- …team members for resolutions of conflicts between status and authorization. Evaluates clinical review (s) and physician documentation for at-risk claims; performs ... contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more