- CareFirst (Baltimore, MD)
- … - State Licensure And/or Compact State Licensure Upon Hire Required + CNS- Clinical Nurse Specialist Preferred **Experience:** 5 years Clinical nursing ... **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective… more
- Stanford Health Care (Palo Alto, CA)
- …improvement activities by identifying opportunities forimprovement in such areas as clinical outcomes, utilization of resources and concurrent data ... clinical and psychosocial information to assurereimbursement. + Utilization Review -- Reviews prospectively, concurrently and retrospectively all inpatients… more
- Sharp HealthCare (San Diego, CA)
- …guidelines.Complies with contracted health plan requirements for documentation of concurrent SNF review and utilization management activities performed ... Day **FTE** 1 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians; Other… more
- Presbyterian Homes and Services (Roseville, MN)
- …end splits, review all expedited appeals and ALJ level appeals. Perform concurrent MDS review to assure appropriate RUGs category is achieved through the ... capture of appropriate clinical information. + Perform monthly QI/QM review ...RAI Directors on the approved plan. Qualifications + Registered nurse with current licensure the State Board of Nursing… more
- AmeriHealth Caritas (Washington, DC)
- …required; Bachelor's Degree in Nursing (BSN) preferred + Minimum of 3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit (ICU), ... necessity for inpatient and outpatient services, ensuring treatment aligns with clinical guidelines, regulatory requirements, and patient needs. This role requires… 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
- 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
- Sharp HealthCare (La Mesa, 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 **Hours** **:** **Shift Start… more
- Trinity Health (Livonia, MI)
- …services. Responsible for charge capture in Revenue Integrity assigned areas. Review 's chart, including nursing notes, physician orders, progress notes, and surgical ... correct encounter, correct date of service, with any required modifiers. Review 's documentation, abstracts data and ensure charges/coding are in alignment within… more
- Guthrie (Troy, 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
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