- Centene Corporation (Sacramento, CA)
- …on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... management team, members, and providers + Monitors prior authorization, concurrent review , and/or retrospective clinical ...all policies and standards **Candidates must have a Registered Nurse (RN) license for California and ability to work… more
- Mount Sinai Health System (New York, NY)
- …/ appeals as specified by Insurance / State & Federal regulation. + Enters concurrent review information for Review Nurses in Allscripts + Obtains/Prepares ... + Process Mail - Sort, identifies location and distribute to appropriate departments + Monitors Concurrent Nurse denial phone calls for UM Nurse to follow +… more
- UPMC (Pittsburgh, PA)
- …delays in discharge. + Documents all Avoidable Days in CANOPY system. + Performs clinical review on admission and/or continued stay using InterQual criteria to ... since its founding in 1890. The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization management, resource… more
- Sharp HealthCare (La Mesa, CA)
- …real and potential quality issues through measurement and analysis along with concurrent and retrospective review of performance information. Assists with ... and managing data collection as well as analyzing, interpreting and presenting clinical quality-related data. + Previous case review experience. **Preferred… more
- Sacramento County (Sacramento, CA)
- …Psychologist, Licensed Clinical Social Worker, Marriage Family Therapist, or Registered Nurse . Note: Failure to maintain a required license may be cause for ... improperly rejected may request the Employment Services Division to review its decision to reject the application. If the...Clinical Social Worker, Marriage Family Therapist, or Registered Nurse . Note: Failure to maintain a required license may… more
- AdventHealth (Tampa, FL)
- …inpatients, sending/presenting opportunities for improved documentation compliance to physicians, nurse practitioners and other clinical team members. ... Research Institute, also located at AdventHealth Tampa, leads the way in clinical and academic research in the areas of neuroscience, cardiovascular medicine,… more
- Prime Healthcare (Chino, CA)
- …for its quality, including as among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. ... nationally recognized, locally preferred, and community focused. Responsibilities The Clinical Documentation Specialist (CDS) is responsible for conducting clinically… more
- Commonwealth Care Alliance (Boston, MA)
- … Nurse and Specialist staff responsible for conducting centralized clinical review and authorization creation for centrally authorized services. This ... Utilization Management reports to the Director of Utilization Management * Oversees clinical decision review for services requiring prior authorization in a… more
- Guthrie (Sayre, PA)
- …two (2) years of hire. Individual consideration may be given to a registered nurse , with significant clinical experience, who holds a bachelor's degree in a ... Case Manager utilizes industry accepted processes for achieving optimal patient, clinical , and operational outcomes timely, coordinated, and in cost effective… more
- Sharp HealthCare (San Diego, CA)
- …patient care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure ... Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM)… more