- Centene Corporation (Olympia, WA)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing...as an RN **or** an LPN + Experience with clinical review processes + Familiarity with the… more
- Cognizant (Olympia, WA)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical … more
- Swedish Health Services (Seattle, WA)
- …focus on what really matters - our patients.** The Utilization Review (UR) Nurse has a strong clinical background blended with a well-developed knowledge and ... reimbursement requirements of commercial and government payers. The UR nurse is responsible for performing admission, concurrent ...that medical necessity indicators are met. + Provides a clinical review of the medical record to… more
- Providence (WA)
- …Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review , Prior Authorization, Medical Audits, Appeals or ... best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …do:** + Performs medical necessity review that includes inpatient review , concurrent review , benefit advisory/prior authorization, retrospective, out ... https://healthsource.premera.com/ . The **Care Coordinator - Retrospective** performs prospective review (benefit advisory/ prior authorization) admission, concurrent ,… more
- Molina Healthcare (Bellevue, WA)
- …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 (WA)
- …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