- Centene Corporation (Nashville, TN)
- …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
- Actalent (Tampa, FL)
- Actalent is hiring a Clinical Review Nurse role! Job Description The Clinical Reviewer is a telephonic position responsible for recommending discharge ... guidelines and collaboration with key facility personnel. + Use clinical expertise to review clinical ...commitment to quality and standards. + 3 years of concurrent review experience and/or discharge planning. +… more
- Children's Mercy Kansas City (Kansas City, MO)
- …can improve the lives of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, ... authorization per contracts for medically appropriate level of care. Manages concurrent clinical denials through completion of verbal reconsideration process.… 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
- Baystate Health (Greenfield, MA)
- **Summary** : The Assistant Nurse Manager (ANM)/ Clinical Nurse Educator (CNE) works in partnership with the nurse manager to support and lead the daily ... of care; along with the coordination of the student nurse clinical experience in the department. Works...mentoring and role modeling. The ANM/CNE, along with the Nurse Manager, performs QI review , collecting and… more
- Montana State University-Northern (Havre, MT)
- …is ten. The CRRN is responsible for the students and must have not have concurrent clinical responsibilities. The CRRN may also be assigned to monitor students ... Clinical Resource Registered Nurse (CRRN) part-time...position including any supplementary documentation and questions you should review before applying for the opening. To apply for… more
- Houston Methodist (The Woodlands, TX)
- … functions through point of entry, observation progression of care management, concurrent review and denials reviews. Additionally, the URSN will prospectively ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is...regarding any claim issues or concern that may require clinical review during the pre-bill, audit, or… more
- Geisinger (Wilkes-Barre, 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...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity...regarding any claim issues or concerns that may require clinical review during the pre-bill, audit, or… more
- CDPHP (Albany, NY)
- …The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes ... exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care… more
- AmeriHealth Caritas (Dover, DE)
- **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient ... services, ensuring treatment aligns with clinical guidelines, regulatory requirements, and patient needs. This role...cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …mentorship and leadership programs + And more! **Description** The **Registry Utilization Review Nurse ** (PRN) is responsible for conducting medical necessity ... designation as guided by criteria guidelines, patient presentation, and clinical nursing judgement. + In addition, concurrent ...by ensuring criteria guidelines applied are addressed in the clinical review . + The UR RN (PRN)… more
- Actalent (Sunrise, FL)
- …and authorization of psychiatric and chemical dependency services, and engaging in concurrent review with hospitals and mental health centers. The specialist ... present reports on department activities as assigned. Essential Skills + Proficiency in clinical review and utilization management. + Knowledge of Interqual and… more
- UNC Health Care (Kinston, NC)
- …assures timely movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of ... the right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care,… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition ... (inpt vs OBS). Facilitates concurrent reviews and authorizations for admissions. This position will...programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. +… more
- Beth Israel Lahey Health (Plymouth, MA)
- …data to establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal ... the care provided to the hospitalized patient. + Conducts concurrent reviews to determine the continued need for acute...degree in healthcare preferred. + Three years recent, broad clinical experience in the hospital setting + Experience with… 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
- Trinity Health (Grand Rapids, MI)
- …medical staff, including clinical practice guidelines and policies in the concurrent or retrospective review of patient medical records. + **Process ... clinical data collection/abstraction, data analysis, reporting, and in-depth clinical review of cases identified for peer...and experience. + Licensed to practice as a Registered Nurse in the State of Michigan + Experience collecting,… more
- AdventHealth (Glendale Heights, IL)
- …team members for resolutions of conflicts between status and authorization. Evaluates clinical review (s) and physician documentation for at-risk claims; performs ... contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more
- ChenMed (North Miami Beach, FL)
- …+ Participates in surveys, studies and special projects as assigned. + Conducts concurrent medical record review using specific indicators and criteria as ... resources and mobilizes resources to assist in achieving desired clinical outcomes within specific timeframe. + Conducts review...clinical field preferred. + A valid, active Registered Nurse (RN) license in State of employment required. +… more