- Centene Corporation (New York, NY)
- …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
- Northwell Health (Lake Success, NY)
- … clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests clarification ... of clinical documentation from the physician(s) on a ...date. *Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications… more
- Northwell Health (Sleepy Hollow, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. ... collaboration with the health care team. + Conducts chart review for appropriateness of admission and continued length of...and continued length of stay; Facilitates throughput. + Conducts clinical reviews and interacts with third party payers to… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Clinical Program Manager for Geriatrics and Palliative Medicine supports the Vice Chair of Quality and Clinical Information and oversees ... as a component within the department or larger health system. The Clinical Program Manager leads quality and performance improvement programs in collaboration with… more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. c. Provides clinical information requested by the ... for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).… more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. 13. Provides clinical information requested by the ... for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).… more
- Mount Sinai Health System (Long Island City, NY)
- …Social Service Department. + When managed care denies payment for days during concurrent review , contact the attending with this information. The attending can ... across the continuum. Ensuring and facilitating the achievement of quality, clinical and cost outcomes; Negotiating, procuring and coordinating services and… more
- Northwell Health (Forest Hills, NY)
- …In concert with attending physician.Responds to third party payer requests for concurrent clinical information providing all relevant documentation to ensure ... Masters Degree, preferred.Current license to practice as a Registered Professional Nurse in New York State.Patient Review Instruments (PRI) Certification,… more
- Molina Healthcare (Yonkers, NY)
- …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 (Yonkers, NY)
- …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
- MVP Health Care (Tarrytown, NY)
- …the Medical Director to ensure appropriate outcomes. + Service Authorization & Review : Conduct prospective, concurrent , and retrospective reviews to determine ... + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within...after hire. + At least 3 years of recent clinical and Case Management experience. Experience working in a… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …+ Assess discharge planning needs at the patient's admission + Perform regular concurrent review on all patients and coordinate all needed services including ... Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of… more