- Children's Mercy KC (Kansas City, MO)
- …resolve issues. The High-Risk Nurse Lead is an expert at the roles of Clinical Review Nurse Care Manager and Care Coordination Case Manager and provides ... lives of children beyond the walls of our hospital. Overview The High-Risk Nurse Lead manages high risk administrative processes and data related to medical… 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 ... Nursing Experience And Skills *Speaks, reads and writes English *5 years of clinical nurse experience *2 years of Case Management experience preferred… more
- Mary Washington Healthcare (Fredericksburg, VA)
- …at both State and National levels. Abstracts and organizes data obtained from concurrent and retrospective chart review of thoracic surgery patient subsets. ... Thoracic Surgery (STS) database. Performs outcomes analysis, identifies trends, initiates review and assists with coordination of MWHC quality improvement team… more
- Cumberland Heights Foundation, Inc. (Nashville, TN)
- …specific third-party payor case managers, to provide the necessary information for concurrent review and benefit authorization for the patient's care, including ... and procedures. Participates in daily and weekly team meetings and treatment plan review , as well as individual and group clinical supervision, according to… more
- MedStar Health (Baltimore, MD)
- …denials. Serves as a resource to all staff in areas of utilization review /management. Utilizes and analyzes current medical/ clinical information as well as ... Candidates with previous Utilization Review or Denials/Appeals experience preferred General Summary of...and monitoring the denial management and appeals process. Combines clinical , business and regulatory knowledge and skill to reduce… 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, ... of care and transitions. Documents discharge planning interventions and utilization review activity per department and medical center standards in a timely… more
- St. Luke's University Health Network (Lehighton, PA)
- …of patient care management. Facilitates insurance authorization, pre-certification, and concurrent reviews for assigned patients. Maintains clinical records ... communication appropriate to the age of the patient treated. Performs admission review on all inpatients. Attends daily patient rounds and shares professional… 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...meeting established goals and modify care plans accordingly. Provide clinical information to health insurers as required. Work closely… more
- Valley Health System (Paramus, NJ)
- POSITION SUMMARY: Performs concurrent utilization review activities on all patients within the assigned caseload. Collaborates and educates the medical staff on ... appropriate utilization review guidelines and documentation in accordance with CMS regulations...in nursing required. EXPERIENCE: Minimum 5 years experience in clinical nursing, minimum of 3 years in case management/… more
- Regency Integrated Health Services (Cuero, TX)
- …Medicare Program are met, such as Physician certification and re-certification. Performs concurrent MDS review to assure appropriate RUGs category is achieved ... - Cuero, TX Position Type Full Time Job Category Nurse Description Primary Responsibilities Responsible for the coordination of...through the capture of appropriate clinical information. Participates in the interdisciplinary team process to… more
- HCA Healthcare (Ocala, FL)
- …and accountability in ensuring all admissions and continued stays meet clinical criteria for appropriateness and medical necessity. Assesses discharge planning needs ... level of care across the continuum. Ensures plan meets patient's clinical , psychological and discharge needs in collaboration with the attending physician… more
- UMC Health System (Lubbock, TX)
- …Monday-Friday 8am-5pm Not fully remote. The Clinical Documentation Specialist (CDS) provides concurrent review of the clinical content in the active ... identifies opportunities for improvement, education, and increased Registered professional nurse who assesses, implements or delegates, plans, and evaluates total… more
- Cedars Sinai (Los Angeles, CA)
- …by assessing their needs, coordinating care, communicating with health plans, including concurrent review to determine the appropriateness of services rendered ... guidelines as necessary. Plans for discharges and care assessments. Submits necessary clinical information to the health plan using the accepted format and… more
- UnitedHealth Group (Evansville, IN)
- …as the link between patients and the appropriate health care personnel, the Clinical Review Coordinator- Onsite is responsible for ensuring efficient, smooth, ... of care Perform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and utilizing CMS criteria upon admission to SNF and periodically… more
- Kaiser Permanente (Decatur, GA)
- …care by chart review and discussion with attending physician, admission and concurrent review for inpatient admissions, meetings with patient and families to ... care for hospitalized members by carrying out daily utilization and quality review , monitoring for inefficiencies and opportunities to improve care, developing a… more
- CareStar, Inc. (Evansville, IN)
- …efforts by focusing on ongoing clinical and compliance issues, staff development, concurrent clinical review and assistance to Case Managers with both ... Clinical Supervisor Indiana - Ready to join a...Licensed Social Worker, Licensed Independent Social Worker or Registered Nurse OR a bachelor's degree in nursing, Social Services,… more
- Molina Healthcare (Long Beach, CA)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. Monitors appropriate care and ... national, state, and local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states: WA FL, MI, MS,… more
- Franciscan Missionaries of Our Lady Health System (Baton Rouge, LA)
- …hours of admission/next working day. b. Assesses patients for needs on initial and concurrent review . c. Notifies all involved entities when admission fails to ... Responsibilities Team 30% a. Completes all job requirements related to prospective, concurrent and retrospective case review and reporting quality issues… more
- Centene Corporation (Little Rock, AR)
- …offering competitive benefits including a fresh perspective on workplace flexibility. Clinical Review Nurse - Concurrent Review & Outpatient Services ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- CVS Health (Annapolis, MD)
- …required with ability to obtain additional licenses as needed. + Utilizes clinical skills to coordinate, document and communicate all aspects of the ... and administration of the utilization/benefit management function + Gathers clinical information and applies the appropriate medical necessity criteria/guideline,… more
