- BayCare Health System (St. Petersburg, FL)
- …respect, responsibility and clinical excellence. **The Team Lead Utilization Review responsibilities include:** + Directing and coordinating the daily operations ... of the UM department responsible for concurrent reviews and observation management + Ensuring that the...clinical nursing **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management) + Preferred CCM… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Part- time and will work 8-hour, Day shifts.** ... of US hospitals are four times designated. Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and… more
- Prime Healthcare (Lynwood, CA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 years post… 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 ... Days, Evenings, Nights available* *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
- University of Southern California (Alhambra, CA)
- …of the major duties of the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate that the appropriate patient ... MCG competency testing. 8. Perform telephonic, and if appropriate, on-site initial/ concurrent review on identified in-patient members. Direct pertinent clinical… 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
- SSM Health (MO)
- …and provides feedback to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, ... observed rate/expected rate (O/E ratios), industry trends, variable and diagnosis review group (DRG) frequency. + Serves as a liaison between coding staff and… more
- Sharp HealthCare (San Diego, CA)
- …position, and employer business practices. **What You Will Do** Perform admission and concurrent review of patients, based upon needs regardless of payor ... patients.Interfaces with Business Office regarding ongoing certification of stay.Provides concurrent and retro UR reviews to Review Organizations.Identifies… more