- Centene Corporation (Sacramento, CA)
- …hold a current CA license.** **Must have** **2-4 years related** **experience in UM- Concurrent Review . 2+ years of acute care experience required. 10% Travel ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Actalent (Dallas, TX)
- Clinical Review Nurse (Utilization...and utilization review expertise. + Experience in concurrent review and prior authorization. + Knowledge ... Remote Job Description The role of the Utilization Management Nurse involves performing concurrent reviews, determining the...concurrent reviews to assess member's overall health. + Review the type of care being delivered and evaluate… 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
- Centene Corporation (Sacramento, CA)
- …administered with quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against ... providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically appropriate determinations +… 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
- LifePoint Health (Hickory, NC)
- *_Registered Nurse (RN), Clinical Case Manager_* *_Fulltime: Days_* * * * * *Schedule:* Monday-Friday 7:30a-4:00p/8:00a-4:30p * *Your experience matters* Frye ... to care. * Coordinates changes to the care plan as needed. *6. Utilization Review & Documentation* * Performs admission and concurrent medical record reviews. *… more
- Houston Methodist (Houston, 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 (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 ... Uses standardized tools to complete assessments in the areas of clinical , functional, financial, support system, psychosocial and cognitive and environmental realms.… 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