- Ascension Health (Tulsa, OK)
- …and coordinate the activities and flow of work for the peer review program. + Collect, evaluate, and maintain practitioner-specific data concerning physician and ... risk-related data. + Coordinate the medical staff's professional performance evaluation and peer review programs in a manner that fulfills the mission and goals of… more
- University of Utah Health (Salt Lake City, UT)
- …appropriateness of admissions with associated levels of care and continued stay review . + Communication to third-party payers for initial and concurrent clinical ... review . + Reviews patient chart to ensure patient continues...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Centene Corporation (Trenton, NJ)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers on utilization… more
- Albany Medical Center (Albany, NY)
- …documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and contacts ... Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies.* Facilitates removal of delays and documents… more
- Hackensack Meridian Health (Hackensack, NJ)
- **The Advanced Practice Nurse (APN) utilizes a patient-centered coordinated care model, demonstrating competencies in leadership, direct clinical practice, ... nursing program. 2. Master's or Doctorate degree from an accredited Nurse Practitioner program. 3. Maintains clinical competencies through continuing education and… more
- Centene Corporation (New York, NY)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... care to members + Provides feedback on opportunities to improve the authorization review process for members + Performs other duties as assigned + Complies with… more
- US Tech Solutions (May, OK)
- …clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews ... . 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior...knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT… more
- Huron Consulting Group (Chicago, IL)
- …for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the Utilization Management Department ... Annapolis, MD + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the system, reporting to the Director of Utilization… more
- UCLA Health (Los Angeles, CA)
- Description The Quality Management Nurse is responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with healthcare standards and ... inspections of clinical areas, patient care practices, and administrative processes + Review medical records of services in preparation for health plan and/or… more
- Highland Hospital (Geneseo, NY)
- …selection).Fax documents from EMR. Utilize menu filters for task views and chart reviewer . Review patient problem list. Review patient allergy list. Navigate ... **17417BR** **Title:** Registered Nurse - Primary Care **Department/Cost Center:** 881 -...the scope of practice intended by the Licensed Registered Nurse regulations of the New York State Nurse… more