- Mount Sinai Health System (Long Island City, NY)
- …Social Service Department. + When managed care denies payment for days during concurrent review , contact the attending with this information. The attending can ... needed by the patient and family. **Qualifications** + **Education:** Registered professional nurse licensed to practice in the state of New York + **Experience:**… more
- Mount Sinai Health System (New York, NY)
- …/ appeals as specified by Insurance / State & Federal regulation. + Enters concurrent review information for Review Nurses in Allscripts + Obtains/Prepares ... Mail - Sort, identifies location and distribute to appropriate departments + Monitors Concurrent Nurse denial phone calls for UM Nurse to follow +… more
- Nuvance Health (Danbury, CT)
- …level of care. Develop clinical criteria and guidelines for efficient UR processes. * * Concurrent Review :* Oversee the concurrent review process, ... leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff...related field preferred * Current licensure as a registered nurse (RN) * Minimum of 5 years of clinical… more
- Centene Corporation (Sacramento, CA)
- …a fresh perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical ... between utilization management team, members, and providers + Monitors prior authorization, concurrent review , and/or retrospective clinical review nurses… more
- Northwell Health (Lake Success, NY)
- …to clarify clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests ... expected risk of mortality, and complexity of care provided. Responsible for concurrent inpatient medical record reviews for Medicare, Medicaid and all commercial… more
- Tufts Medicine (Burlington, MA)
- …an all-inclusive list. Other duties and responsibilities may be assigned. 1. Performs initial concurrent review of new patients every day and concurrent ... at Home **Job Overview** The position is responsible for review and analysis of the medical record to improve...I:** 1. Associate's degree in Nursing 2. Active Registered Nurse (RN) license in Massachusetts or compact state 3.… more
- SSM Health (Madison, WI)
- …Initiate quality improvement projects G. Lead stroke quality improvement teams/meetings H. Concurrent chart review I. Participation in the inpatient rounds for ... Stroke Center. Key Duties include: A. Stroke policy and procedure development and review B. Responsible for compliance with all Federal and State regulatory statutes… more
- CareFirst (Baltimore, MD)
- …Navigator RNs. Utilizes MCG to act as a resource for the nurses to conduct concurrent review for medical necessity and appropriate level of care for Commercial ... Management. + Oversees associates conducting care coordination activities including concurrent review utilizing MCG. Collaborates with CareFirst medical… more
- Mount Sinai Health System (New York, NY)
- …the clinical information requested by the managed care companies as part of the concurrent review in a timely fashion. c. Provides clinical information requested ... Requirements + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a… more
- UNC Health Care (Goldsboro, NC)
- …as needed. 3. Works with Clinicians and Coders to successfully implement documentation review for MS-DRG and AP-DRG payers on assigned Hospital Units. 4. Utilizes ... in Clinician documentation, and to formulate and generate clear, compliant and concurrent questions to those Clinicians. 5. Utilizes inpatient admission criteria to… more