- 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
- Trinity Health (Syracuse, NY)
- …administrative requirements for Utilization Management and works collaboratively with Utilization Management/ Concurrent Review Nurse , physicians, staff and ... possible concurrent denials, forwards information to the appropriate Utilization Management/ Concurrent Review Nurse within identified process standards *… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... 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
- Cognizant (Albany, NY)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization… more
- Albany Medical Center (Albany, NY)
- …environment. + Basic knowledge of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure and/or ... financial constraints. + Provides collaborative care management with the primary nurse in assessing for discharge planning needs, coordinating appropriate resources… more
- Northwell Health (Syosset, NY)
- …weekdays_ + Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. ... patient in collaboration with the health care team. + Conducts chart review for appropriateness of admission and continued length of stay; Facilitates throughput.… more
- Northwell Health (Poughkeepsie, 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...+ Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications… more
- Centene Corporation (New York, NY)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... member's - ages 0-18.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Northwell Health (Lake Success, NY)
- …to clarify clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests ... expected risk of mortality, and complexity of care provided. Responsible for concurrent inpatient medical record reviews for Medicare, Medicaid and all commercial… more
- Mount Sinai Health System (New York, NY)
- …the clinical information requested by the managed care companies as part of the concurrent review in a timely fashion. c. Provides clinical information requested ... Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager or a minimum… more
Recent Jobs
-
Engineering Manager GPU Virtualization
- Broadcom (Palo Alto, CA)
-
Big Data Support Engineer Lead - Vice President
- Citigroup (Irving, TX)
-
IT Systems Engineering Analyst
- Huntington Ingalls Industries (Wright Patterson AFB, OH)