- Centene Corporation (Indianapolis, IN)
- …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
- Centene Corporation (Austin, TX)
- …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
- Centene Corporation (Jefferson City, MO)
- …administered with quality, cost efficiency, and are within compliance. + Performs a clinical review and assessment of relevant complex post-care services by ... providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically appropriate determinations +… more
- Hartford HealthCare (Manchester, CT)
- …of care in the acute-care setting. * Minimum of 1 year Utilization Review experience preferred via industry clinical standards, ie, InterQual, Milliman Care ... or assign other duties and responsibilities to this position * Conducts concurrent and retrospective review (s) utilizing InterQual (IQ), Milliman Care Guidelines… more
- Actalent (Miami, FL)
- Urgent Hiring for "Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and protect ... other and complete cases. Qualifications: + 3+ years of utilization management, concurrent review , prior authorization, utilization review , case management,… more
- Vitalief (Philadelphia, PA)
- …role will support the planning, implementation, and execution of multiple concurrent clinical research studies, including NIH-sponsored, industry-sponsored, and ... operate more efficiently and grow sustainably. The Role We are seeking an experienced Clinical Research Nurse to join our exceptional team as a full-time… 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 ... work on site position located in Danville, Pennsylvania. The Clinical Documentation Improvement Program (CDI) is designed to improve...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- CentraCare (St. Cloud, MN)
- …Job Category: Nursing Job Schedule: Full time CentraCare is looking for a qualified Clinical Documentation Nurse to join our team! This role is responsible for ... concurrent auditing of medical record documentation to evaluate the...Documentation Specialist (CCDS) preferred + National Certification as a Clinical Documentation Specialist-Outpatient (CCDS-O) preferred + Utilization review… 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 ... Job Summary The Clinical Documentation Improvement Program (CDI) is designed to...Dayshift; Monday through Friday. Candidates must hold a Registered Nurse license in Pennsylvania or a Multistate License. A… 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 ... case management and clinical transplant experience + Valid and active Registered nurse (RN) licensure in all 50 states and the District of Columbia initiated… more
- Ansible Government Solutions (Memphis, TN)
- …success as if it is their own. Responsibilities + Act as the Registered Nurse Advisor for the facility's CDI program, focusing on both inpatient and outpatient ... services + Review health records concurrently to identify opportunities for improved...identify opportunities for improved documentation and coding accuracy using clinical knowledge and critical thinking skills + Support CDI… more
- Cedars-Sinai (Los Angeles, CA)
- …Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent Denials supports post-discharge clinical reviews for Medicare Short Stay ... defensible clinical submissions, coordinate peer-to-peer reviews, and respond to concurrent denials. + This position requires strong regulatory knowledge, sound … more
- UNC Health Care (Kinston, NC)
- …+ Minimum 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience ... clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria… more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality/Utilization Review Nurse Position Summary: The Quality/Utilization Review Nurse is responsible for evaluating the medical necessity, ... infection prevention protocols and regulatory compliance. Key Responsibilities: * Utilization Review : o Conduct concurrent and retrospective reviews of patient… more
- University of Utah Health (Salt Lake City, UT)
- …and continued stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient ... expected cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Ventura County (Ventura, CA)
- …and patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review , case management, ... may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent , retrospective, out of network and medical… more
- LA Care Health Plan (Los Angeles, CA)
- …in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff, physicians, providers, ... Utilization Management Nurse Specialist RN II Job Category: Clinical...productive workplace environment. Perform telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff,… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Rush University Medical Center (Chicago, IL)
- …the medical necessity, appropriateness, and quality of care. Applies criteria, performs concurrent review process. Works with physicians and Medical Director ... clinical needs throughout the continuum of care. The Nurse Care Manager 1 functions as a liaison between...regarding Case issues and concurrent denials an indicated. 6. Applies pathways/guidelines, assesses variances,… more
- Stanford University (Stanford, CA)
- …supervision. CERTIFICATIONS & LICENSES: * Current license as a California Registered Nurse . * Certified Research Administrator or Clinical Research Coordinator ... Research Nurse 2 **School of Medicine, Stanford, California, United...Post Date Dec 31, 2025 Requisition # 107827 The Clinical and Translational Research Unit (CTRU) is the leading… more