- Ventura County (Ventura, CA)
- …patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review , case management, and ... Senior Medical Management Nurse - VCHCP...are not limited to the following: + Performs utilization review with pre-certification, concurrent , retrospective, out of… 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
- 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 ... 40 hours weekly; Dayshift; Monday through Friday. Candidates must hold a Registered Nurse license in Pennsylvania or a Multistate License. A minimum of 3 years… more
- Sacramento County (Sacramento, CA)
- …Employment Qualifications Minimum Qualifications Either: One year of experience as a Senior Public Health Nurse in Sacramento County service. Or: Two ... improperly rejected may request the Employment Services Division to review its decision to reject the application. If the...+ I have one year of experience as a Senior Public Health Nurse in Sacramento County… more
- Geisinger (Danville, PA)
- …PI Program and Trauma Registry. + Maintains trauma roster and updates on concurrent basis. + Summarizes concurrent daily chart rounding information into monthly ... quality improvement report and forwards initial review to leadership for secondary review and...of 3 years-Nursing (Required) Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania OUR PURPOSE &… more
- Geisinger (Danville, PA)
- …National Healthcare Safety Network (NHSN) reporting criteria and requirements. + Performs concurrent and retrospective medical record review including review ... Top 8 Most Innovative Healthcare Systems in Becker's Hospital Review , we're working to create a national model for...and DOH surveys. At least 2 years of Registered Nurse work experience in a hospital setting is required.… more
- Geisinger (Scranton, PA)
- …As one of the Top 8 Most Innovative Healthcare Systems in Becker's Hospital Review , we're working to create a national model for improving health. Today, we're ... universal life and pet and legal insurance Position Details The Registered Nurse Care Manager works with physician and multidisciplinary team members to develop… 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 ... of pre-transplant, transplant, and post-transplant claims. Sets up transplant pre-pay review for each individual claim. Reviews transplant billing packets and… 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 ... DRG assignment, risk of mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of records every 3 days to… more
- Sacramento County (Sacramento, CA)
- Senior Mental Health Worker-Licensed Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1036656) Apply Senior Mental Health Worker-Licensed ... plans with little direct supervision; provide direction to and review the work of assigned staff. + Establish and...the State of California to practice as a Registered Nurse , Vocational Nurse or Psychiatric Technician AND… more
- Elevance Health (Miami, FL)
- Med Management Clinician Senior - Licensed Nurse **Location:** Miami, FL **Hybrid 1** : This role requires associates to be in-office 1-2 days a week, fostering ... Friday, 8:00AM - 5:00PM Eastern Time The **Medical Management Clinician Senior ** is responsible for ensuring appropriate, consistent administration of plan benefits… more
- Kaleida Health (Buffalo, NY)
- …team, Nursing, Patient Management, Quality Department and ancillary staff to perform concurrent analytical review of clinical documentation and coding data. ... ** Senior Clinical Doc Specialist** **Location:** Larkin Bldg @...of the health care team. Also responsible for audit review to identify potential documentation deficiencies in specific records… more
- Elevance Health (Louisville, KY)
- **Medical Management Clinician Senior ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... 8a - 5p EST (with weekend rotation)** The **Medical Management Clinician Senior ** is responsible for ensuring appropriate, consistent administration of plan benefits… more
- GE Vernova (Boston, MA)
- …oversight of suppliers thru procurement and construction to develop, perform, and review unit, module, system, and integration test plans, procedures, and reports ... Engineer-Procure-Construct (EPC) partner(s), and suppliers. + Perform detailed oversight, review , and verification of deliverables from suppliers to ensure their;… 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
- Oracle (Harrisburg, PA)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... and patient care improvements. Manage the nursing needs for multiple concurrent optimization projects, from requirements analysis and solution design to testing,… more
- BayCare Health System (Tampa, FL)
- …other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient ... of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior /RN responsibilities include:** + Functions as the… more
- Centene Corporation (New York, NY)
- …am - 5:00 pm with holiday rotation.** **Position Purpose:** Manages Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... and facilitates operations within utilization management. + Manages prior authorization, concurrent review , and retrospective clinical review team… more
- Centene Corporation (Madison, WI)
- …with rotating weekend / holiday coverage. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical ... between utilization management team, members, and providers + Monitors prior authorization, concurrent review , and/or retrospective clinical review nurses… more
- Sacramento County (Sacramento, CA)
- …clinic. OR: Two years of experience in the class of Mental Health Counselor, Psychiatric Nurse , Senior Mental Health Counselor, Senior Psychiatric Nurse , ... Licensed Clinical Social Worker, Marriage and Family Therapist, or Registered Nurse . AND Either: Two years of experience coordinating and/or supervising mental… more