- 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 ...+ Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications… more
- Cognizant (Phoenix, AZ)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical … more
- AdventHealth (Celebration, FL)
- …in the defeat of illness and disease **The role you'll contribute:** The Clinical Nurse Education Facilitator (CNEF) is an expert clinician, highly skilled ... thinking, critical reflection, and life-long learning to adapt quickly to changing clinical environments and escalating patient care needs. The CNEF will use a… 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
- 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
- Beth Israel Lahey Health (Boston, MA)
- …being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for ... a Registered Nurse (RN), Massachusetts + Three years of recent clinical or utilization management experience _Preferred:_ + Bachelor's degree in nursing or… 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
- CDPHP (Latham, 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
- 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