- BayCare Health System (St. Petersburg, FL)
- …that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Team Lead Utilization Review responsibilities include:** + ... the daily operations of the UM department responsible for concurrent reviews and observation management + Ensuring that the...**Position** Utilization Review Team Lead **Location** St Petersburg:St Anthonys | Clinical | Full Time **Req ID**… more
- UPMC (Mechanicsburg, PA)
- The Manager oversees the day-to-day operations of the Clinical Care Coordination and Discharge Planning Department under the direction of the Director. The Manager ... for timely and accurate documentation of appropriate data relating to concurrent denials. Assures regulatory compliance in determining denial of service and/or… more
- Providence (Mission Hills, CA)
- …retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all ... **Description** **RN Utilization Review - Remote. This position will work full-...by the health plans. This role requires a strong clinical background combined with well-developed knowledge and skills in… more
- Prime Healthcare (Lynwood, CA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum...of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five… 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
- University of Southern California (Alhambra, CA)
- …8. Perform telephonic, and if appropriate, on-site initial/ concurrent review on identified in-patient members. Direct pertinent clinical ... quality patient care. The Case Manager will leverage their clinical and social work experience to ring an understanding...of the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate… 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
- 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
- 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