- Mayo Clinic (Rochester, MN)
- …multi-disciplinary teams. Major Functions of the RN Case Manager include: Utilization Review , including concurrent admission status and continued stay clinical ... education to clinical staff regarding quality metrics, and continued admission status review to ensure accurate clinical documentation to support the care provided.… more
- Emory Healthcare/Emory University (Duluth, GA)
- …admission reviews within 24 hours or first business day following admission, daily review of medical necessity for all inpatients, concurrent stay documentation ... of observation patients per hospital policy; + Maintains documentation of utilization review function per hospital policy and federal and state requirements; +… more
- Trinity Health (Maywood, IL)
- …campus. Position is hybrid, must reside in Illinois. The **Regional Utilization Review Documentation Specialist** nurse works with the multidisciplinary team ... of procedural cases and submitting/monitoring post acute authorization status. Admission and Concurrent Case Review : + Uses approved criteria for admission and… more
- UCLA Health (Los Angeles, CA)
- …and family. Ability to represent the Medical Center in site visits and review by managed care, insurance groups, and regulatory entities. + Ability to provide ... ability to work independently and prioritize workload. Ability to manage numerous concurrent tasks in a high stress environment and deal with change. Preferred:… more
- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... the hospitalized patient. + Conducts concurrent reviews to determine the continued need for acute care setting, appropriateness and timeliness of… 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
- AdventHealth (Altamonte Springs, FL)
- …role you will contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to determine ... order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… 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: - ... within the Greater Sacramento, CA region.** **Position Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing utilization management (UM… more
- Centene Corporation (Raleigh, NC)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more