- Centene Corporation (Des Moines, IA)
- …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
- Cleveland Clinic (Cleveland, OH)
- …with one of the most respected healthcare organizations in the world. As a Concurrent Denial Nurse , you will support the Utilization Management Department by ... criteria is met. We are looking for a Registered Nurse who is a subject matter expert in utilization...to the department in general and the hospital. + Review and analyze concurrent and retrospective clinical… more
- Cedars-Sinai (Los Angeles, CA)
- …Hospitals. Summary of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent Denials supports post-discharge ... Short Stay cases and assists with real-time management of concurrent payer denials. + This role ensures timely, accurate,...Coordination **Req ID** : 14355 **Working Title** : Registered Nurse -Utilization Review Case Manager - 8… more
- George C. Grape Community Hospital (Hamburg, IA)
- Quality/Utilization Review Nurse Position Summary: The Quality/Utilization Review Nurse is responsible for evaluating the medical necessity, ... infection prevention protocols and regulatory compliance. Key Responsibilities: * Utilization Review : o Conduct concurrent and retrospective reviews of patient… more
- UNC Health Care (Kinston, NC)
- …the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria ... of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service,...3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review ,… more
- Centene Corporation (Jefferson City, MO)
- …providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically appropriate determinations + ... on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review and assessment of complex services previously provided to determine… more
- University of Utah Health (Salt Lake City, UT)
- …continued stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient continues ... cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by nursing judgment and/or...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Actalent (Atlanta, GA)
- …(Rotating weekends) About the Role We are seeking a detail-oriented and compassionate Utilization Review Registered Nurse (RN) to join our team. In this role, ... Job Title: Utilization Review RN Location: Buckhead, GA (on-site position) Schedule:...experience. + BLS and CPR certifications. + Experience with concurrent , prospective, and retrospective reviews. + Familiarity with case… more
- Ventura County (Ventura, CA)
- …and patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review , case management, ... may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent , retrospective, out of network and medical… more
- LA Care Health Plan (Los Angeles, CA)
- …in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff, physicians, providers, ... Utilization Management Nurse Specialist RN II Job Category: Clinical Department:...productive workplace environment. Perform telephonic and/or onsite admission and concurrent review , and collaborates with onsite staff,… more