- Alameda Health System (San Leandro, CA)
- …utilization review functions, including response to payor requests for concurrent and retrospective review information including Medicare and MediCal ... Nurse , Care Management + San Leandro, CA +...develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care,… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …The **Care Coordinator** - ** Clinical Appeals** performs prospective review (benefit advisory/ prior authorization) admission, concurrent , and retrospective ... Performs medical necessity review that includes inpatient review , concurrent review , benefit advisory/prior...experience (REQUIRED) + Current State Licensure as a registered nurse (REQUIRED) + Three (3) years of clinical… more
- Bryan Health (Lincoln, NE)
- …duties are also required in the department noted above. Performs utilization review activities, including concurrent and retrospective reviews as required. ... SUMMARY: The Care Transitions RN conducts day-to-day activities for the clinical , psychosocial and utilization coordination of the patients hospital experience.… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …do:** + Performs medical necessity review that includes inpatient review , concurrent review , benefits advisory/prior authorization, retrospective, out ... **Care Coordinator - Inpatient RN** performs reviews of admissions and concurrent stay requests for acute hospitalizations, skilled nursing, and inpatient… more
- Commonwealth Care Alliance (Boston, MA)
- … Nurse and Specialist staff responsible for conducting centralized clinical review and authorization creation for centrally authorized services. This ... Utilization Management reports to the Director of Utilization Management - Oversees clinical decision review for services requiring prior authorization in a… more
- Stanford Health Care (Palo Alto, CA)
- …activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection;participates ... third-party payers to assure reimbursement for patient services/procedures. Communicates with review organizations / payers to provide requested clinical and… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …+ Assess discharge planning needs at the patient's admission + Perform regular concurrent review on all patients and coordinate all needed services including ... Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of… more
- Centene Corporation (Columbus, OH)
- …, InterQual knowledge, and discharge planning.** **Additional Details:** Department: Concurrent Review MCD** Business Unit: Corporate** Schedule:** ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Centene Corporation (Baton Rouge, LA)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… 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
- 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 ...+ Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications… 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
- AdventHealth (Celebration, FL)
- …in the defeat of illness and disease **The role you'll contribute:** The Clinical Nurse Education Facilitator (CNEF) is an expert clinician, highly skilled ... thinking, critical reflection, and life-long learning to adapt quickly to changing clinical environments and escalating patient care needs. The CNEF will use a… 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
- 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 ... case management and clinical transplant experience + Valid and active Registered nurse (RN) licensure in all 50 states and the District of Columbia initiated… 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
- 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
- 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
- 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
