- Centene Corporation (Tallahassee, FL)
- …flexibility. **Must Reside in Florida!** **Centene is Hiring!** **We're looking for a Remote Concurrent Review Nurse to support our Medicaid team.** **Ideal ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a CDI Concurrent Review and Query Specialist? At HCA Healthcare, you come first. HCA Healthcare ... a difference. We are looking for a dedicated CDI Concurrent Review and Query Specialist like you...to physicians for conflicting, imprecise, incomplete, illegible, or inconsistent clinical documentation. This individual need to function in a… more
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt of high ... medical services, notification of emergent hospital admissions, completes inpatient concurrent review , establishes discharge plans, coordinates transitions of… more
- Independent Health (Buffalo, NY)
- …benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review to ... nurse (RN) required. + Two (2) years of clinical experience as an RN in a varied ...documentation of clinical information for medical necessity review of all requests, procedures, admissions, and concurrent… more
- Houston Methodist (Houston, TX)
- … functions through point of entry, observation progression of care management, concurrent review and denials reviews. Additionally, the URSN will prospectively ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is...regarding any claim issues or concern that may require clinical review during the pre-bill, audit, or… more
- UNC Health Care (Kinston, NC)
- …+ Minimum 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience ... clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria… 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
- 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
- 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
- Dignity Health (Chandler, AZ)
- …the general direction of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the ... with applicable standards and regulations and provide information and education to clinical care providers in order to achieve optimal clinical , financial,… more
- Dignity Health (Gilbert, AZ)
- …the general direction of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the ... with applicable standards and regulations and provide information and education to clinical care providers in order to achieve optimal clinical , financial,… more
- YesCare Corp (Brentwood, TN)
- …+ Assist in the control of utilization of resources, pre-occurrence monitoring, concurrent monitoring, intervention and retrospective review . + Track, trend and ... a pioneer in correctional healthcare services, YesCare is committed to innovation, clinical expertise, and compassionate care. By choosing a career with YesCare, you… 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
- 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
- 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
- Ventura County (Ventura, CA)
- …and patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review , case management, ... may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent , retrospective, out of network and medical… more
- Veterans Affairs, Veterans Health Administration (Leavenworth, KS)
- …analytical review of clinical information. Responsibilities The Revenue Utilization Review (RUR) Registered Nurse is under the supervision of a Nurse ... on Service Connection (SC), non-SC, Special Authority (SA), precertification, prospective review , concurrent review , denial management, retrospective … 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