- 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
- Centene Corporation (Jefferson City, MO)
- …on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review and assessment of complex services previously provided to determine ... quality, cost efficiency, and are within compliance. + Performs a clinical review and assessment of relevant complex post-care services by reviewing medical records… 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 (Denver, CO)
- …to identify and implement opportunities for improvement. + Oversees the clinical review of outcomes including creating and editing correspondence letters with the ... and NCQA standards + Provides expert insight and guidance on the clinical review process of correspondence to ensure compliance with all applicable State and Federal… 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
- 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
- Hackensack Meridian Health (Hackensack, NJ)
- **The Per Diem Advanced Practice Nurse (APN) for Utilzation Review utilizes a patient-centered coordinated care model, demonstrating competencies in leadership, ... nursing program. 2. Master's or Doctorate degree from an accredited Nurse Practitioner program. 3. Maintains clinical competencies through continuing education and… more
- Stony Brook University (Stony Brook, NY)
- …effective patient care. + For Nurse Practitioners - Assistance in the annual review Nurse Practitioner protocols. This is a faculty academic position at the ... Critical Care Medicine at the Clinical Instructor level. The Nurse Practitioner/Physician Assistant will join physician faculty of the...event of an unsatisfactory outcome of the disclosure and review process, an offer of employment may be revoked… more
- Evolent (Lansing, MI)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Lawrence General Hospital (Lawrence, MA)
- …referrals and facilitates appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care Leader to ensure all ... the range to support future salary growth. As the Complex Care Nurse Manager provides evidence-based assessments, tools, information, and resources that enhance and… more