- HCA Healthcare (Houston, TX)
- …Registered Nurse Clinical Reviewer opening. Our team will promptly review your application. Highly qualified candidates will be contacted for interviews. ... in their positions. Join our Team as a(an) Registered Nurse Clinical Reviewer and access programs to assist with...resource to Hospital and Medical Staff + Responsible for concurrent audits of patient charts. Inputs data for tracking,… more
- Blue KC (Workman, MN)
- …authorization letters, and follows in FACETS UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside medical ... of pre-transplant, transplant, and post-transplant claims. Sets up transplant pre-pay review for each individual claim. Reviews transplant billing packets and… more
- Geisinger (Danville, PA)
- …provided. The core of the program uses highly trained staff members to perform a concurrent inpatient review of the record. This allows the record to be coded ... DRG assignment, risk of mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of records every 3 days to… more
- Nuvance Health (Danbury, CT)
- …are executed to the appropriate level within the care continuum. Provides clinically based concurrent review of the medical record to assess and procure accurate ... liaison between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate status is assigned.… more
- Prime Healthcare (Riverdale, GA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... accredited school of nursing and a current state Registered Nurse license. + Grandfathered prior to April 1, 2015....accredited school of nursing and a current state Registered Nurse license. + Grandfathered prior to April 1, 2015.… more
- Northwell Health (Staten Island, NY)
- **Req Number** 167724 Registered Nurse Case Manager - FlexStaff Serves as liaison between the patient and facility/physician. Ensures a continuum of quality patient ... Responsibilities: + Facilitates patient management throughout hospitalization + Performs concurrent utilization management using evidence based medical necessity criteria… more
- Omaha Children's Hospital (Omaha, NE)
- …of service for the severity of illness. UM includes retrospective and concurrent clinical reviews with third-party payors and actively collaborates with NCM and ... Guides admitting physician in protocols for conducting physician to physician review with third-party payers. * Appropriately documents all relevant communications… more
- Northwell Health (Mount Kisco, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. ... patient in collaboration with the health care team. + Conducts chart review for appropriateness of admission and continued length of stay; Facilitates throughput.… more
- Wellpath (Fort Lauderdale, FL)
- …and acute care using InterQual Criteria, ensuring adherence to department procedures. * Review concurrent clinical information and document it in the ERMA Care ... of care support. **How you make a difference** The Utilization Management Registered Nurse works under the guidance of the Utilization Provider to oversee the… more
- CVS Health (AZ)
- …+ Minimum of 1 year of experience in Oncology and Transplant either in UM, concurrent review , or prior authorization + 3+ years of experience in Acute clinical ... of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and Transplant, you'll play a vital role… more