- Trinity Health (Boise, ID)
- …compliance. Provides concurrent assistance and support to physicians and other clinical members of the health care team in coordinating the delivery ... management/utilization review and discharge planning collaboratively determining level of care needs beyond acute care , providing decision support to… more
- SNCH (Oceanside, NY)
- …management, coordination, and follow-up of all concurrent and retrospective inpatient clinical denials. The Denial Review Coordinator is to provide the ... benefits. Status : Per Diem Shift: VARIED SHIFT Department: Care Coordination Position Summary Summary: The Denial Review...Skills *Speaks, reads and writes English *5 years of clinical nurse experience *2 years of Case Management experience… more
- Children's Mercy KC (Kansas City, MO)
- …address and resolve issues. The High-Risk Nurse Lead is an expert at the roles of Clinical Review Nurse Care Manager and Care Coordination Case Manager ... written appeal, and final appeal outcome to identify and resolve insurance/payer issues; clinical care delivery concerns; Care Coordinator performance improv… more
- Advocate Aurora Health (Kenosha, WI)
- …UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, ... in clinical innovation, health outcomes, consumer experience and value-based care . Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6… more
- Valley Health System (Paramus, NJ)
- …SKILLS: Registered Nurse, Licensed in State of New Jersey, Current acute care clinical knowledge with broad-base medical / surgical background. Demonstrates ... POSITION SUMMARY: Performs concurrent utilization review activities on all...in nursing required. EXPERIENCE: Minimum 5 years experience in clinical nursing, minimum of 3 years in case management/… more
- Northwestern Medical Center (St. Albans, VT)
- …$33.50 to $54.00 USD Nurse Care Manager JOB SUMMARY: Conduct individualized concurrent clinical evaluations of patients, their health needs, and concerns; ... review patient medical record for medical necessity, develop personalized...monitor patients' progress in meeting established goals and modify care plans accordingly. Provide clinical information to… more
- Cedars Sinai (Los Angeles, CA)
- …their needs, coordinating care , communicating with health plans, including concurrent review to determine the appropriateness of services rendered and ... and InterQual guidelines as necessary. Plans for discharges and care assessments. Submits necessary clinical information to...and ISP Hospitalists assigned to the SNF's for continued review and follow up. Communicates transition of care… more
- Cumberland Heights Foundation, Inc. (Nashville, TN)
- …payor case managers, to provide the necessary information for concurrent review and benefit authorization for the patient's care , including providing ... toward patient's goals in establishing ongoing recovery management, including review and revision of the plan of care...practices as defined within the Cumberland Heights Model of Care . Documents clinical activities in patient record… more
- MedStar Health (Baltimore, MD)
- …and implements strategies to avoid denials and improve efficiency in delivery of care through review and examination of denials. Identifies system delays in ... service to improve the provision of efficient and timely patient care . Identifies process issues related to the concurrent Case Management system, including… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …rising risk, and high-risk members' utilization of services in all settings (outpatient, inpatient, concurrent review , and transitions of care ). 3. Take a ... strategy, network performance improvement, quality improvement, medical economics, and value-based care contracts. 7. Provide oversight of the clinical … more
- Acadia Healthcare (Moosic, PA)
- …providers. Maintain knowledge of clinical information for patient's stay by review of documentation, participate in staffing, attend care conferences and ... collaborate with other members of the treatment team. Perform concurrent review with network providers; monitor medical record documentation using knowledge of… more
- St. Luke's University Health Network (Lehighton, PA)
- …patient care management. Facilitates insurance authorization, pre-certification, and concurrent reviews for assigned patients. Maintains clinical records of ... to the age of the patient treated. Performs admission review on all inpatients. Attends daily patient rounds and...AND EXPERIENCE: At least 2 to 5 years of clinical experience providing care to patients with… more
- UnitedHealth Group (Evansville, IN)
- …informed decisions. By serving as the link between patients and the appropriate health care personnel, the Clinical Review Coordinator- Onsite is responsible ... Optum Home & Community Care , part of the UnitedHealth Group family of...Perform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and utilizing CMS criteria upon admission to… more
- Ampcus (San Francisco, CA)
- …protocols, including coordination of the data/specimen collection and operations of several concurrent clinical research studies under the guidelines of research ... of conducting a clinical trial. This requires close interaction with patient care staff, research team members and study personnel at other sites. Study duties… more
- HCA Healthcare (Ocala, FL)
- …level of care across the continuum. Ensures plan meets patient's clinical , psychological and discharge needs in collaboration with the attending physician and ... auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services… more
- UnitedHealth Group (Springfield, TN)
- …management experience Experience or exposure to discharge planning Experience in utilization review , concurrent review or risk management Experience working ... At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers...experience, creating healthier communities and removing barriers to quality care . The work you do here impacts the lives… more
- Blue Shield of California (Oakland, CA)
- …of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at ... The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members...various levels of care for medical necessity, coding accuracy, medical policy compliance… more
- Blue Shield of California (Oakland, CA)
- …this role, you will: Complete assigned clinical reviews (IP Admission and Concurrent , Lower Level of Care , Preservice requests, Post-service medical claim ... In this role you will deliver and collaborate on clinical review activities, which includes management of...of FEP membership to provide access to high-quality health care to these members Serve as a clinical… more
- Kaiser Permanente (Decatur, GA)
- … by chart review and discussion with attending physician, admission and concurrent review for inpatient admissions, meetings with patient and families to ... quality review , monitoring for inefficiencies and opportunities to improve care , developing a safe discharge plan to include recommending alternative levels and… more
- Summa Health (Akron, OH)
- … experience. -Two years' experience providing intensive outpatient or partial hospitalization clinical care preferred. -Must have (or attain within one year) ... the Behavioral Health Intensive Outpatient Program. Works as part of a clinical treatment team that includes the medical and administrative directors of outpatient… more
