- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Stony Brook University (Stony Brook, NY)
- …or higher) in Nursing. Current registration to practice as a Licensed Registered Nurse in New York State. One (1) year post-licensure nursing experience. One (1) ... such matter or in the event of an unsatisfactory outcome of the disclosure and review process, an offer of employment may be revoked at SBU's sole discretion. If SBU… more
- Albany Medical Center (Albany, NY)
- …and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and contacts ... assigned patients.* Discusses payor criteria and issues and a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.* Uses… more
- Amergis (Houston, TX)
- …of the nursing process and the delivery of patient care. The Pediatric Registered Nurse (RN) demonstrates ability to make clinical judgments in an effective and ... + Minimum of one year of maternal child health acute clinical experience or Pediatric Registered Nurse (RN) experience within the last three years preferred. +… more
- Huron Consulting Group (Chicago, IL)
- …Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new ... partnerships, clinical services and technology is not enough to create...planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the Utilization… more
- Dignity Health (Chandler, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of ... with applicable standards and regulations and provide information and education to clinical care providers in order to achieve optimal clinical , financial,… more
- Dignity Health (Gilbert, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of ... with applicable standards and regulations and provide information and education to clinical care providers in order to achieve optimal clinical , financial,… more
- University of Washington (Seattle, WA)
- …outstanding opportunity for a **Registered Nurse -** **Second Level Review / Review Coordinator Clinical Documentation Integrity Specialist.** **WORK ... position will also participate in various projects and initiatives within the Clinical Documentation Program. Based on findings, department goals and initiatives and… more
- Centene Corporation (Trenton, NJ)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... within the Eastern Standard Time Zone.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- Centene Corporation (Jefferson City, MO)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... including a fresh perspective on workplace flexibility. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical… more