- Kaiser Permanente (San Francisco, CA)
- …Utilization Management: Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and ... of nursing. Diploma/Associate Degree Nursing. License, Certification, Registration Registered Nurse License (California) Basic Life Support Additional Requirements: Knowledge… more
- Stanford Health Care (Palo Alto, CA)
- …improvement activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection; ... payers to assure reimbursement for patient services/procedures. Communicates with review organizations/payers to provide requested clinical and psychosocial… 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
- MVP Health Care (Rochester, NY)
- …. The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This individual ... will make triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum...health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required New York State license required Licensed… more
- MVP Health Care (Rochester, NY)
- …with the Medical Director to ensure appropriate outcomes. Service Authorization & Review : Conduct prospective, concurrent , and retrospective reviews to determine ... bring: Current New York State Licensure as a Registered Nurse required. Certification in Case Management required within 24...months after hire. At least 3 years of recent clinical and Case Management experience. Experience working in a… more
- Centene Corporation (Trenton, NJ)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a CDI Concurrent Review and Query Specialist? At HCA Healthcare, you come first. HCA Healthcare ... a difference. We are looking for a dedicated CDI Concurrent Review and Query Specialist like you...to physicians for conflicting, imprecise, incomplete, illegible, or inconsistent clinical documentation. This individual need to function in a… 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
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- …in patient care through systematic evaluation and analytical review of clinical information. Responsibilities Responsibilities of the RUR nurse include, but ... on Service Connection (SC), non-SC, Special Authority (SA), precertification, prospective review , concurrent review , denial management, retrospective … more
- UNC Health Care (Kinston, NC)
- …+ Minimum 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience ... clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria… more
