- Centene Corporation (Jefferson City, MO)
- …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
- Cognizant (Jefferson City, MO)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical … more
- Blue KC (MO)
- …authorization letters, and follows in FACETS UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside medical ... case management and clinical transplant experience + Valid and active Registered nurse (RN) licensure in all 50 states and the District of Columbia initiated… more
- CVS Health (Jefferson City, MO)
- …clinical criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review . + Conduct clinical reviews via phone and ... members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key Responsibilities**...At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong… more
- Centene Corporation (Jefferson City, MO)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine… more
- Banner Health (MO)
- …thoroughly completes documentation required for claims payment of services approved through concurrent review 2. Supervises the team to ensure internal/external ... clinical denials. Collaborates with Care Coordination, physician, Utilization Review , and other internal/external departments to overturn and/or reduction of… more
- Missouri State University (Springfield, MO)
- …provided to patients. 5. Develops and implements processes for retrospective patient care review , concurrent assessment of clinical practice, credential and ... first date of consideration is November 18, 2025, and review of applications will continue until the position is...availability and role requirements. Option 1 + One full-time Nurse Practitioner (NP) or Physician Assistant (PA), and +… more
Recent Searches
- CNA Certified Nurse Assistant (United States)
- Vice President People Human (Pennsylvania)
- Sr Engineer PAM (United States)
- CT Rad Technologist Hanover (United States)
Recent Jobs
-
Sr. Accountant
- Robert Half Finance & Accounting (Washington, DC)
-
Remedial Management Senior Officer - Senior Vice President
- Citigroup (Irving, TX)
-
Nurse Manager - Adult Psych
- Hartford HealthCare (Bridgeport, CT)
-
SharePoint Administrator Expert (SME) - TS/SCI required
- General Dynamics Information Technology (Fort Belvoir, VA)