- Centene Corporation (Des Moines, IA)
- …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
- CVS Health (Phoenix, AZ)
- …outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and ... members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role, you'll be at the forefront of… more
- Trinity Health (Columbus, OH)
- …and other operational departments regarding case management issues. + Conducts inpatient concurrent review . + Documents and communicates to QM staff ... **Shift:** Day Shift **Description:** Please note position is 100% remote , however colleagues who reside within a 50mile radius...with the Plan's UM and QM Program and the review of the Plan's Medical Management Plan. **What we… more
- Actalent (Columbus, OH)
- "Immediate Hiring for "Utilization Review RN" Job Description: + Perform concurrent reviews to assess member's overall health. + Review the type of care ... + 4+ years experience in utilization management and utilization review /managed care/hospital setting as an RN is Mandatory...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
- Centene Corporation (Jefferson City, MO)
- …providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically appropriate determinations + ... on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review and assessment of complex services previously provided to determine… more
- Vitalief (Philadelphia, PA)
- …and grow sustainably. The Role We are seeking an experienced Clinical Research Nurse to join our exceptional team as a full-time Vitalief employee. In this ... plans. + Hybrid schedule : 4 days on-site (Philadelphia), 1 day remote weekly. + Market-competitive salary , commensurate with experience. Responsibilities: + Under… 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 ... PA, but may allow for some days to be remote in the future. The role is full-time, 40...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests ... needs of FH members and their families. The PA Nurse is responsible for assuring the receipt of high...from medical care providers as needed for the clinical review process * Conducts pre-authorization and concurrent … more
- International Medical Group (Indianapolis, IN)
- …an active RN license in good standing in Indiana. + Location: Hybrid or Remote working options. + Corporate office is in Indianapolis, IN. + Relocation Expenses ... of the use of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between the Insured, the… more
- BrightSpring Health Services (Sheridan, IN)
- …meetings + Chairs committees as appropriate, eg safety, infection control, incident review , and human rights committees + Facilitates communication and serves as a ... with current registration of practice as a Registered Professional Nurse + Must be an excellent communicator and possess...an excellent communicator and possess the ability to handle concurrent tasks and responsibilities + Must be able to… more