- UNC Health Care (Hendersonville, NC)
- …* Identifies performance improvement issues through direct observation of clinical care , concurrent chart review , staff reporting, and attendance at ... serve. Summary: The Trauma Process Improvement Coordinator evaluates and monitors the quality of clinical care of the injured patient across the continuum of … more
- Beth Israel Lahey Health (Cambridge, MA)
- …interpreting quality data, and implement quality improvement initiatives to deliver excellence in clinical care . + Provides concurrent monitoring of all ... to collect data for reporting quality measures, including both concurrent medical record review and periodic medical...medical peer review . 5. Excellent understanding of clinical aspects of care . Applies knowledge of… more
- AdventHealth (Orlando, FL)
- …support the appropriate severity of illness, expected risk of mortality, and complexity of care of the patient. The Second Level Reviewer I educates members of ... team regarding documentation guidelines, including physicians, allied health practitioners, nursing, and care management. The Second Level Reviewer I adheres to… more
- AdventHealth (Altamonte Springs, FL)
- …support the appropriate severity of illness, expected risk of mortality, and complexity of care of the patient. The Second Level Reviewer I educates members of ... team regarding documentation guidelines, including physicians, allied health practitioners, nursing, and care management. The Second Level Reviewer I adheres to… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …rehabilitation and other services within scope of practice per business needs. The reviewer will ensure services align with established clinical guidelines and ... is part of a larger team and works independently and collaboratively to facilitate care using clinical skills, principles of managed care , nationally… more
- SSM Health (MO)
- …Tennessee, Texas, Utah, Virginia, West Virginia, and Wisconsin.** **Job Summary:** Performs concurrent analytical reviews of clinical and coding data to ... Highlights:** Additional Job Description Must have prior experience as a Clinical Documentation Specialist **Required Qualifications:** + **1 year of experience as… more
- SSM Health (MO)
- …provides feedback to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, ... rate/expected rate (O/E ratios), industry trends, variable and diagnosis review group (DRG) frequency. + Serves as a liaison...Specialist (ACDIS) EXPERIENCE + Two years in an acute care setting with two years experiencein clinical … more
- Magellan Health Services (Honolulu, HI)
- …telephone triage, crisis intervention and emergency authorizations as assigned. + Performs concurrent reviews for inpatient and/or outpatient care and other ... of care . General Job Information Title HMSA Care Manager - BH, UM Reviewer -...- Required CEAP - Certified Employee Assistance Professional - Care MgmtCare Mgmt, LCSW - Licensed Clinical … more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …is preferred for all positions. **POSITION PURPOSE** The Behavioral Health Utilization Reviewer is responsible for conducting clinical reviews of behavioral ... requests, claims, and appeals to confirm medical necessity and appropriateness of care . The reviewer applies evidence-based criteria including InterQual and/or… more
- Centene Corporation (Sacramento, CA)
- …CA license.** **Must have** **2-4 years related** **experience in UM- Concurrent Review . 2+ years of acute care experience required. 10% Travel required.** ... care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions...to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical … more