- Centene Corporation (Salem, OR)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- Cleveland Clinic (Vero Beach, FL)
- …to the department in general and the hospital. + Review and analyze concurrent and retrospective clinical denials and follow the specific payer processes. + ... most respected healthcare organizations in the world. As a Concurrent Denial Nurse , you will support the...you will support the Utilization Management Department by reviewing concurrent and retrospective clinical inpatient denials to… more
- Baystate Health (Springfield, MA)
- …Minimum - Midpoint - Maximum $87,859.00 - $100,984.00 - $119,412.00 **UM Outpatient Clinical Review Nurse - Baystate Health, Health New England** **This ... **remote opportunity** **.** **Current States Eligible MA and CT** The **UM Outpatient Clinical Review Nurse ** contributes to the overall success of… more
- Centene Corporation (Jefferson City, MO)
- …administered with quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against ... providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically appropriate determinations +… more
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse is responsible for ensuring the receipt of high quality, cost ... medical services, notification of emergent hospital admissions, completes inpatient concurrent review , establishes discharge plans, coordinates transitions of… more
- Hartford HealthCare (Manchester, CT)
- …of care in the acute-care setting. * Minimum of 1 year Utilization Review experience preferred via industry clinical standards, ie, InterQual, Milliman Care ... or assign other duties and responsibilities to this position * Conducts concurrent and retrospective review (s) utilizing InterQual (IQ), Milliman Care Guidelines… more
- Veterans Affairs, Veterans Health Administration (Smyrna, TN)
- …on Service Connection (SC), non-SC, Special Authority (SA), precertification, prospective review , concurrent review , denial management, retrospective ... of VHA and industry best standards. The Revenue Utilization review (RUR) Registered Nurse (RN) is an...clinical denials for revenue. Performs legal case relatedness review for revenue billing purposes. Provides education to VA… more
- Cedars-Sinai (Los Angeles, CA)
- …Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent Denials supports post-discharge clinical reviews for Medicare Short Stay ... defensible clinical submissions, coordinate peer-to-peer reviews, and respond to concurrent denials. + This position requires strong regulatory knowledge, sound … more
- Vitalief (Philadelphia, PA)
- …role will support the planning, implementation, and execution of multiple concurrent clinical research studies, including NIH-sponsored, industry-sponsored, and ... operate more efficiently and grow sustainably. The Role We are seeking an experienced Clinical Research Nurse to join our exceptional team as a full-time… more
- Geisinger (Danville, PA)
- …provided. The core of the program uses highly trained staff members to perform a concurrent inpatient review of the record. This allows the record to be coded ... work on site position located in Danville, Pennsylvania. The Clinical Documentation Improvement Program (CDI) is designed to improve...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more