- Centene Corporation (Des Moines, IA)
- …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
- Actalent (Tampa, FL)
- …other and complete cases. Qualifications: + 3+ years of utilization management, concurrent review , prior authorization, utilization review , case management, ... Urgent Hiring for " Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and protect… more
- CVS Health (Phoenix, AZ)
- …outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and ... members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role, you'll be at the forefront of… more
- Trinity Health (Columbus, OH)
- …and other operational departments regarding case management issues. + Conducts inpatient concurrent review . + Documents and communicates to QM staff ... **Shift:** Day Shift **Description:** Please note position is 100% remote , however colleagues who reside within a 50mile radius...with the Plan's UM and QM Program and the review of the Plan's Medical Management Plan. **What we… more
- Actalent (Houston, TX)
- "Immediate Hiring for "Utilization Review RN" Job Description: + Perform concurrent reviews to assess member's overall health. + Review the type of care ... + 4+ years experience in utilization management and utilization review /managed care/hospital setting as an RN is Mandatory...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
- Centene Corporation (Jefferson City, MO)
- …providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically appropriate determinations + ... on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review and assessment of complex services previously provided to determine… more
- Vitalief (Philadelphia, PA)
- …and grow sustainably. The Role We are seeking an experienced Clinical Research Nurse to join our exceptional team as a full-time Vitalief employee. In this ... plans. + Hybrid schedule : 4 days on-site (Philadelphia), 1 day remote weekly. + Market-competitive salary , commensurate with experience. Responsibilities: + Under… more
- CentraCare (St. Cloud, MN)
- …Nursing Job Schedule: Full time CentraCare is looking for a qualified Clinical Documentation Nurse to join our team! This role is responsible for concurrent ... medical record documentation to evaluate the documentation and utilization review of services to adequately reflect care provided and...+ Full-time | 80 hours every two weeks | Remote after training + Days | 8-hour shifts |… 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 ... PA, but may allow for some days to be remote in the future. The role is full-time, 40...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests ... needs of FH members and their families. The PA Nurse is responsible for assuring the receipt of high...from medical care providers as needed for the clinical review process * Conducts pre-authorization and concurrent … more
- International Medical Group (Indianapolis, IN)
- …an active RN license in good standing in Indiana. + Location: Hybrid or Remote working options. + Corporate office is in Indianapolis, IN. + Relocation Expenses ... of the use of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between the Insured, the… more
- BrightSpring Health Services (Sheridan, IN)
- …meetings + Chairs committees as appropriate, eg safety, infection control, incident review , and human rights committees + Facilitates communication and serves as a ... with current registration of practice as a Registered Professional Nurse + Must be an excellent communicator and possess...an excellent communicator and possess the ability to handle concurrent tasks and responsibilities + Must be able to… more
- Actalent (Sacramento, CA)
- …(CCM), CPUR, or CPHM credential preferred but not required . Background in concurrent review or inpatient census oversight preferred. . Strong critical thinking, ... representatives . Conduct in-person hospital rounds 2-3 days per week, telephonic review and participate in interdisciplinary case reviews . Escalate complex or… more
- Trinity Health (Livonia, MI)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Purpose** Work Remote Position (Pay Range: $24.5303-$36.7954) Provides oversight & support of ... services. Responsible for charge capture in Revenue Integrity assigned areas. Review 's chart, including nursing notes, physician orders, progress notes, and surgical… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** **This position is remote . Candidates must be local to New England States for consideration** The Clinical ... Documentation Improvement (CDI) Specialist Registered Nurse (RN) assists with the appropriate identification of diagnoses, conditions, and/or procedures that are… more
- Stanford Health Care (Palo Alto, CA)
- …charging error, substandard documentation and inaccurate procedural billing. + Performs concurrent review of hospital bills to document non-billed, underbilled, ... development and reporting of findings. + Prepares written reports of review findings and recommendations and presents to management and maintains monitoring… more
- Vanderbilt University Medical Center (Nashville, TN)
- …procedures independently. Documents the patient's clinical status and care provided. Performs concurrent review of patient records for documentation to support ... of emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC-Registered Nurse - Licensure-Others **Work Experience:** Relevant Work Experience **Experience… more
- Centene Corporation (Austin, TX)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... + Experience working with providers and healthcare teams to review care services, precertification, concurrent review...and Family Therapist required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Centene Corporation (Springfield, IL)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... fresh perspective on workplace flexibility. NOTE: NOTE: This is a fully remote completing reviews for Youth-In-Care or Former Youth-In-Care members, ages 0-21… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization review plans… more