- UPMC (York, PA)
- UPMC is hiring a Manager, Clinical Care Coordination and Discharge for our hospital in York! This is a full time, day shift position with NO weekends and NO holidays ... to apply! Purpose: The Manager oversees the day-to-day operations of the Clinical Care Coordination and Discharge Planning Department under the direction of the… more
- Guthrie (Binghamton, NY)
- …management. 7. Seeks consultation from appropriate discipline/department as needed to expedite clinical review of potential and actual denials. + Education 1. ... government payers. The UM RN responsibilities include performing a variety of concurrent and retrospective UM-related clinical reviews and revenue cycle… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work onsite. ... *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include supervising staff… more
- UTMB Health (Galveston, TX)
- …mechanism for the review of quality of care issues arising during concurrent review , identifies area of potential medical liability and communicates to ... Utilization Review Case Mgr - Galv. Campus Utilization Mgt...and current Texas Nursing licensure as a professional registered nurse . Minimum of three years of full time wage… more
- Genesis Healthcare (Charles Town, WV)
- …of the MDS assessments including case-mix, OBRA and OSRA required assessments. *Perform concurrent MDS review to insure appropriate RUGs category is achieved ... impact in the communities we serve. Responsibilities The MDS Nurse -- RN manages the overall process and tracking...through the capture of appropriate clinical information and in this process identify opportunities to… more
- Brockton Hospital (Brockton, MA)
- …Medicine, Nursing, Case Management, the Quality Department and ancillary staff to perform concurrent analytical review of the medical record to ensure an ... current license from Commonwealth of Massachusetts to practice as a Registered Nurse Experience: Minimum of five years clinical experience required.… more
- Centene Corporation (Tallahassee, FL)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine… more
- Dignity Health (Rancho Cordova, CA)
- …This position may be assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review . Responsibilities may include: - ... the Greater Sacramento, CA region.** **Position Summary:** The Utilization Review (UR) LVN uses clinical judgement in...LVN experience. - Clear and current CA Licensed Vocational Nurse (LVN) license. - Knowledge of health plans. Medical… more
- Queen's Health System (Honolulu, HI)
- …responsible for competency in coordinating and performing day-to-day operations, providing concurrent and/or retrospective review , and improving documentation of ... LICENSURE: * Current Hawaii State license as a Registered Nurse . * Associate degree in nursing or higher. *...to the case management process. o Ability to interpret clinical information and assess implications for treatment. o Ability… more
- Molina Healthcare (Henderson, NV)
- …experience with MCG guidelines. At least 2 years of experience with inpatient concurrent review , prior authorization and managed care; Acute care hospital ... **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes....equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more