- Centene Corporation (Olympia, WA)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing...as an RN **or** an LPN + Experience with clinical review processes + Familiarity with the… more
- Cognizant (Olympia, WA)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical … more
- Molina Healthcare (Tacoma, WA)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the… more
- Molina Healthcare (Tacoma, WA)
- …requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care ... for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation… more