- Northwell Health (New Hyde Park, NY)
- …to clarify clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests ... of mortality, and complexity of care provided. Responsible for concurrent inpatient medical record reviews for Medicare, Medicaid and...of employment date. *Current License to practice as a Registered Professional Nurse in New York State… 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...graduate of an accredited school of nursing with current RN or LVN ** Position may be filled by… more
- Denver Health (Denver, CO)
- …case management, DRG coordination, physician education, Medicaid/Medicare reimbursement. Required Licenses : RN - Registered Nurse - DORA - Department of ... We are recruiting for a motivated Clinical RN Documentation Specialist to join our team! We...well as coding guidelines and policies. Essential Functions : Concurrent and/or retrospective review of designated inpatient,… more
- HCA Healthcare (Nashville, TN)
- …PI database to ensure adequate documentation as required by regulatory agencies. Complete concurrent review of cases to identify quality, timelines and systems ... We care like family! Jump-start your career as an RN Trauma Performance Improvement Coordinator. This is a Work...What qualifications you will need: Basic Cardiac Life Support Registered Nurse Associate Degree, or Bachelors Degree… more
- Central Health (Austin, TX)
- …years of nursing experience in an inpatient setting or case management- Required Licenses and Certifications: Registered Nurse License in the State of Texas ... for Central Health covered healthcare services and monitoring patient progress for concurrent reviews. The Utilization Management RN will work in conjunction… more
- UnitedHealth Group (Gastonia, NC)
- … registered clinical license required in state of hire - Registered Nurse , Physical Therapist, Occupational Therapist, or Speech Language Pathologist ... link between patients and the appropriate health care personnel, the Clinical Review Coordinator- Onsite is responsible for ensuring efficient, smooth, and prompt… more
- Heywood Hospital (Gardner, MA)
- …and/or Insurance Industry preferred Minimum License and Certifications Current Massachusetts Registered Nurse License Required Skills Interqual experience or ... weekends, Rotating holidays Responsibilities Essential Functions: Utilization Management- Utilization Review and Care Transitions & Coordination Providing clinical information… more
- Trinity Health (Berwyn, IL)
- …1-2 years of managerial experience. CPR (Cardiopulmonary Resuscitation) certification. Current Registered Nurse License State of Illinois Specialty certification ... Description: The Lead Case Manager position reports to the Manager of Nurse Care Management. Their specific duties include: Recruiting, interviewing, hiring, and… more
- Baptist Memorial Health Care Corporation (Columbus, MS)
- …plan. Preferred/Desired Licensure Minimum Required License/Certification/Registries (valid for the State of MS): Registered Nurse ( RN ) by the State Board of ... criteria within the first 24 hours of arrival to complete an initial review . Collaborate with physicians, Manager of Case Management and physician advisors to… more
- Kaiser Permanente (Atlanta, GA)
- …care by chart review and discussion with attending physician, admission and concurrent review for inpatient admissions, meetings with patient and families to ... of experience. Education Associates Degree Nursing. License, Certification, Registration Registered Professional Nurse License (Georgia) Additional Requirements:… more
- Baptist Health (Alabaster, AL)
- …areas. Acts as an advocate for patient's health care needs. Performs admission and concurrent utilization review in compliance with review requirements for ... contracts, governmental payors (ie Medicare, Medicaid, and Champus) and departmental review policies; adheres to Utilization Management Plan. Communicates in an… more
- AdventHealth (Burleson, TX)
- …winning facility and departments including "Great Place to Work" by Becker's Hospital Review and Gallup. Work with the latest technology and top experts including ... which also provides a low-cost of living. The role you'll contribute: The RN Trauma Program Specialist supports the optimal outcome for injured patients by… more
- Luminis Health (Lanham, MD)
- Position Objective: Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and ... to decrease avoidable delays and denial of payment. Essential Job Duties: 1. Chart Review : Reviews the medical record by applying utilization review criteria,… more
- The University of Vermont Health Network (Burlington, VT)
- …a clinical leader providing and coordinating care to patients and families. Concurrent utilization and service review , consultation, patient and family ... committee work are required of this position EDUCATION: Current RN licensure or compact licensure recognized by the State...candidates hired into, or current employees promoted to, a RN position will be required to obtain their BSN… more
- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- …training needs. Function as Utilization Review /Denials Manager as required. Qualifications Registered Nurse ( RN ) with a Texas license; relevant ... and best practices. Monitor patient care coordination, LOS (length of stay), concurrent review , and transitions to prevent readmissions. Liaise with medical… more
- Renown Health (Reno, NV)
- …speaking English. Appropriate education to obtain and maintain State of Nevada Registered Nurse licensure. Bachelor of Science in Nursing preferred. Experience: ... The Case Manager works closely with the Utilization Management RN who performs admission and concurrent continued...Ability to obtain and maintain a State of Nevada Registered Nurse license Certification(s): National Certification (ie… more
- Magellan Health, Inc. (San Diego, CA)
- …Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher...this role with necessary degrees, LMSW, LCSW, LPC, or RN . Minimum 5 years experience post degree in healthcare,… more
- MetroPlusHealth (New York, NY)
- …agency (CHHA), Lombardi program and/or MLTC Active New York State License as Registered Nurse Professional Competencies Integrity & Trust Customer Service Focus ... Using the assessments and interview done by the Assessment Nurse , the Care Manager identifies the risk factors, strengths,...the MetroPlus Health members Coordinate with UM department on concurrent and retrospective review . Follow up with… more
- Advocate Aurora Health (Kenosha, WI)
- …information is developed further in the departmental job standards. License/Registration/Certification: Registered Nurse License issued by the state in which ... of care and transitions. Documents discharge planning interventions and utilization review activity per department and medical center standards in a timely… more
- Actalent (Fort Lauderdale, FL)
- …Medical management Medicare Managed care Patient care Medical record Case management Concurrent review Discharge planning Medical Acute care Additional Skills & ... Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse...cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care,… more
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