- HonorHealth (AZ)
- …urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, ... Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services… more
- HonorHealth (AZ)
- …urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, ... it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of health care services… more
- Saint Luke's (Kansas City, MO)
- **Job Description** The Utilization Review RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization review ... of the multidisciplinary and revenue cycle teams. + Completes initial and concurrent reviews; identifies appropriate level of service and length of stay, using… more
- Henry Ford Health System (Warren, MI)
- …criteria and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical experience ... of hospital resources and the quality of patient care rendered. Combines clinical , business, regulatory knowledge, and skill to reduce significant financial risk and… more
- LA Care Health Plan (Los Angeles, CA)
- …prospective, concurrent , post-service, and retrospective claim medical review processes. Utilizes clinical judgement, independent analysis, critical-thinking ... and processes. Actively participates in the discharge planning process, including providing clinical review and authorization for alternate levels of care, home… more
- Fallon Health (Worcester, MA)
- … information from medical care providers as needed for the clinical review process + Conducts pre-authorization and concurrent clinical reviews requests ... Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review ...review according to policy and procedure + Documents clinical , functional, psychosocial information in the Core System as… more
- Nuvance Health (Danbury, CT)
- …care. Develop clinical criteria and guidelines for efficient UR processes. * * Concurrent Review :* Oversee the concurrent review process, monitoring ... leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical ...nurse (RN) * Minimum of 5 years of clinical experience in an acute care setting * Minimum… more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. c. Provides clinical information requested by the ... for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).… more
- SSM Health (Madison, WI)
- …Initiate quality improvement projects G. Lead stroke quality improvement teams/meetings H. Concurrent chart review I. Participation in the inpatient rounds for ... Stroke Center. Key Duties include: A. Stroke policy and procedure development and review B. Responsible for compliance with all Federal and State regulatory statutes… more
- Mount Sinai Health System (Long Island City, NY)
- …Social Service Department. + When managed care denies payment for days during concurrent review , contact the attending with this information. The attending can ... across the continuum. Ensuring and facilitating the achievement of quality, clinical and cost outcomes; Negotiating, procuring and coordinating services and… more