- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …oversees all Clinical Services (CS) functions (prior authorization, concurrent review , appeals, case management, disease management, population health) ... a full-service health plan administrator is looking for a full-time dynamic clinical leader who will provide leadership, oversight and accountability for our … more
- AdventHealth (Daytona Beach, FL)
- …for inpatients, sending/presenting opportunities for improved documentation compliance to physicians, nurse practitioners and other clinical team members. + ... 32117 **The role you'll contribute:** Under general supervision of the Director of Clinical Documentation Integrity and in some situations the supervision of the … more
- Sacramento County (Sacramento, CA)
- Licensed Vocational Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448956) Apply Licensed Vocational Nurse D/CF Salary ... 7/2/2026, 10/2/2026 In a detention/correctional facility, the Licensed Vocational Nurse D/CF performs a wide variety of vocational nursing...+ Use and care of medical equipment used in clinical and infirmary settings + Basic medical indications of… more
- Sacramento County (Sacramento, CA)
- Registered Nurse D/CF (Level I/II) Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/454059) Apply Registered Nurse D/CF (Level I/II) ... pm on: 9/4/2025, 11/6/2025, 1/2/2026, 3/5/2026, 5/7/2026, 7/2/2026, 9/3/2026, 11/5/2026 Registered Nurse D/CF Level I: $62.99 - $76.57 hourly Registered Nurse … more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the CMHS. ... Apply qualitative and quantitative analytical techniques, such as prospective, concurrent , and retrospective reviews. Determine the effectiveness of healthcare… more
- Cedars-Sinai (Beverly Hills, CA)
- …by assessing their needs, coordinating care, communicating with health plans, including concurrent review to determine the appropriateness of services rendered ... Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas'...of care and level of care. Use evidence based review guidelines to conduct utilization review as… more
- 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
- Beth Israel Lahey Health (Burlington, MA)
- …Candidates must be local to New England States for consideration** The Clinical Documentation Improvement (CDI) Specialist Registered Nurse (RN) assists with ... of Morality (ROM), during an inpatient hospitalization. CDI Specialist RN initiates concurrent queries to providers as supported by medical record documentation to… more
- Mount Sinai Health System (New York, NY)
- …preferred. + Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign ... 4. Conducts Root Cause Analysis investigations which include assessing need for focused review by departments, and/or clinical chairpersons for peer reviews. 5.… more
- Providence (Beaverton, OR)
- …Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review , Prior Authorization, Medical Audits, Appeals or ... best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care… more