- MVP Health Care (Tarrytown, NY)
- …requires innovative thinking and continuous improvement. To achieve this, we're looking for a ** Leader , Concurrent Review ** to join #TeamMVP. If you have a ... review . + 2+ years of supervisory experience + Strong understanding of concurrent review , sub-acute care, rehabilitation, and skilled nursing services. +… more
- Datavant (Augusta, ME)
- …(prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time ( concurrent review ). You will manage a cross-functional team of product ... the product vision, strategy, and roadmap for the Prospective Suspecting and Concurrent Review solutions within Datavant's Clinical Insights Platform suite. +… more
- Trinity Health (Maywood, IL)
- …of procedural cases and submitting/monitoring post acute authorization status. Admission and Concurrent Case Review : + Uses approved criteria for admission and ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Utilization Review - RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal Hospitals.… more
- Nuvance Health (Danbury, CT)
- …integration of denials prevention operations such as prior authorization, initial and concurrent review , and denials management into other internal and external ... departments to ensure compliance with regulatory requirements and optimize the utilization review process. *Responsibilities:* * Lead and manage daily operations… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …reduction - focusing on 30 days, all causes * Assist with the segmentation of concurrent review offerings into Medicare / Medicaid / Commercial Payors, as needed ... be a key member of the medical staff and take on the role as leader of the Hospital's utilization review /management committee, which is charged with adhering to… more
- Mohawk Valley Health System (Utica, NY)
- …the application of the 2nd Midnight across payor types (CMS regulation). + Perform concurrent review and escalation of cases not meeting criteria. + Provide ... (RAC's). + Assist with mitigating barriers to discharge and care progression. + Perform concurrent review of cases greater than 4 days or the assigned/estimated… more
- Nuvance Health (Danbury, CT)
- …level of care. Develop clinical criteria and guidelines for efficient UR processes. * * Concurrent Review :* Oversee the concurrent review process, ... *Description* *Summary:*The *System Care Coordination Leader * will serve as a pivotal force in...and contribute to the UR committee meetings. * *Utilization Review (UR):* * *Proactive UR:* Lead a… more
- CareFirst (Baltimore, MD)
- …Navigator RNs. Utilizes MCG to act as a resource for the nurses to conduct concurrent review for medical necessity and appropriate level of care for Commercial ... Management. + Oversees associates conducting care coordination activities including concurrent review utilizing MCG. Collaborates with CareFirst medical… more
- CVS Health (CT)
- …ensuring timely and consistent responses to members and providers related to precertification, concurrent review , and appeal request. The medical director is a ... * Utilization management - The medical director will perform concurrent and prior authorization reviews with peer to peer...medical director will participate in and be able to lead daily rounds. **Required Qualifications:** Minimum 3-5 years of… more
- Cedars-Sinai (Beverly Hills, CA)
- …assessing their needs, coordinating care, communicating with health plans (including concurrent review , which assists the hospitalist/specialist and case manager ... Little More About What You Will be Doing** The Lead Case Manager will assist in the daily operations...and case manager assigned to the SNF's for continued review and follow up. + Authorize all appropriate services… more
- Carle Health (Champaign, IL)
- …Field, Work Experience: Clinical bedside; CDI Responsibilities Conducts the initial concurrent review process for all selected admissions. Clarifies ... Overview Performs inpatient chart review to determine appropriate DRG assignment and assures...in EPIC and CDI software and notifies one up leader of any issues. May serve as an "expert"… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …Medical Management Coordinator RNs, Medical Management Coordinators. + Manages the daily concurrent review process through department staff, including review ... staff, based upon established goals and objectives. Key Responsibilities: + Lead and manage the day-to-day operations of the Medical Management department,… more
- AdventHealth (Tampa, FL)
- …documentation to defend code assignment. May serve as the coding expert on the concurrent review process ensuring all coded data is accurately reflected and ... home to the renowned AdventHealth Pepin Heart Institute, a recognized leader in cardiovascular disease prevention, diagnosis, treatment and leading-edge research… more
- PeaceHealth (Vancouver, WA)
- …status, documentation for medical necessity of admission and continued hospitalization and concurrent review . Educates patients and families about their hospital ... Active Labor Act (EMTALA). Serve as a clinical resource and/or liaison. + Lead "progression of care" transition rounds, assigning cases to MSW/Discharge planner for… 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 ... pre-transplant, transplant, and post-transplant claims. Sets up transplant pre-pay review for each individual claim. Reviews transplant billing packets...the center of everything we do. As a market leader , we continue to embrace new ideas to make… more
- Molina Healthcare (Idaho City, ID)
- …authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate ... clinical quality improvement activity (QIA) in collaboration with the clinical lead , the medical director, and quality improvement staff. + Facilitates conformance… more
- Trinity Health (Boise, ID)
- …needs. Reassesses, monitors, and modifies transition needs as appropriate. Conducts concurrent medical record review using established medical necessity criteria ... **Description:** **GENERAL SUMMARY AND PURPOSE:** Provides hospital case management/utilization review and discharge planning collaboratively determining level of care… more
- SSM Health (Madison, WI)
- …quality improvement projects G. Lead stroke quality improvement teams/meetings H. Concurrent chart review I. Participation in the inpatient rounds for stroke ... of the stroke program to improve patient care. The Coordinator is the lead facilitator of the multidisciplinary team responsible for stroke care, including hospital… more
- Concurrent Technologies Corporation (HI)
- CONTROL SYSTEMS ENGINEER/INSPECTOR SENIOR SME Concurrent Technologies Corporation MCB Hawaii Minimum Clearance Required: Secret Clearance Level Must Be Able to ... Obtain: Secret As a trusted partner and leader in providing energy and sustainability consulting services to the federal government, Concurrent Technologies… more
- Sharp HealthCare (San Diego, CA)
- …and responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management, and concurrent and retrospective review ... services, and oversees the health care needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its' Chief Medical Officer.… more