- Centene Corporation (Columbus, OH)
- …, InterQual knowledge, and discharge planning.** **Additional Details:** Department: Concurrent Review MCD** Business Unit: Corporate** Schedule:** ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Cognizant (Columbus, OH)
- …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
- CVS Health (Columbus, OH)
- …clinical criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review . + Conduct clinical reviews via phone and ... members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key Responsibilities**...At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong… more
- Molina Healthcare (Columbus, OH)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care ... Collaborates with contracting department in contract negotiations. * Fosters clinical practice guideline implementation and evidence-based medical practices. *… more
- Trinity Health (Westerville, OH)
- …going above and beyond to provide the highest standards of care. The Clinical Documentation Specialists will concurrently review medical records and assist ... physicians in removing the barriers between clinical and coding languages to allow more specific and...model of the ANCC Magnet Recognition Program(R). + Conducts concurrent reviews of selected patient records to address legibility,… more
- Molina Healthcare (Columbus, OH)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in… more
- Molina Healthcare (Columbus, OH)
- …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 (Columbus, OH)
- …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