- 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)
- …preferred. + Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign ... 4. Conducts Root Cause Analysis investigations which include assessing need for focused review by departments, and/or clinical chairpersons for peer reviews. 5.… more
- Centene Corporation (New York, NY)
- …be working with our Children member's - ages 0-18.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance ... medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine… 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
- Centene Corporation (New York, NY)
- …Utilization Management** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... between utilization management team, members, and providers + Monitors prior authorization, concurrent review , and/or retrospective clinical review … more
- MVP Health Care (Tarrytown, NY)
- …. The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This individual ... will make triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum...health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required + New York State license required… 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
- 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
- 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
- Nuvance Health (Norwalk, CT)
- …are executed to the appropriate level within the care continuum. Provides clinically based concurrent review of the medical record to assess and procure accurate ... *Description* * Clinical Care Coordinator/RN Case Manager - Per Diem...between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate status is… more