- Guthrie (Binghamton, NY)
- Summary The Registered Nurse (RN) Utilization Management (UM) in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and payers, ... payers. The UM RN responsibilities include performing a variety of concurrent and retrospective UM-related clinical reviews and revenue cycle functions ensuring… more
- HonorHealth (AZ)
- …Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- HonorHealth (AZ)
- …it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of health care services ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Saint Luke's (Kansas City, MO)
- **Job Description** The Utilization Review RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization review ... of the multidisciplinary and revenue cycle teams. + Completes initial and concurrent reviews; identifies appropriate level of service and length of stay, using… more
- Providence (Mission Hills, CA)
- **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... **Required Qualifications:** + Associate's Degree Nursing. + Upon hire: California Registered Nurse License. + 2 years Experience working in a remote UR environment… more
- Henry Ford Health System (Warren, MI)
- …and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous ... and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical experience required. +… more
- Nuvance Health (Danbury, CT)
- …payers. * If concurrent inpatient case does not meet medical necessity review criteria during the first level review , discuss with the attending MD ... REQUIRED* * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within… more
- LA Care Health Plan (Los Angeles, CA)
- …not limited to, placement (with level of care) criteria (MCG, InterQual), concurrent review , and discharge planning. Preferred: Consistent Critical Care ... physical therapy, infusion), and case management referrals (5%) Performs prospective, concurrent , post-service, and retrospective claim medical review processes.… more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests ... needs of FH members and their families. The PA Nurse is responsible for assuring the receipt of high...from medical care providers as needed for the clinical review process + Conducts pre-authorization and concurrent … more
- Tufts Medicine (Burlington, MA)
- …and regulatory compliance related to the CDI and coding functions. 2. Performs initial concurrent review of new patients every day and concurrent re-reviews ... Overview** The role of the position is responsible for concurrent and retrospect review and analysis of...Qualifications:** 1. Bachelor's Degree in Nursing 2. Active Registered Nurse (RN) license in Massachusetts or compact state 3.… more