- Centene Corporation (New York, NY)
- …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
- WMCHealth (Valhalla, NY)
- Nurse , Performance Improvement Trauma Coordinator Company: NorthEast Provider Solutions Inc. City/State: Valhalla, NY Category: Nursing/Nursing Management ... and works closely with the Trauma Registry to ensure accurate concurrent data collection and identification of performance improvement occurrences. The Performance… more
- Northwell Health (Sleepy Hollow, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. ... collaboration with the health care team. + Conducts chart review for appropriateness of admission and continued length of...and continued length of stay; Facilitates throughput. + Conducts clinical reviews and interacts with third party payers to… more
- Vitalief (New Brunswick, NJ)
- …in New Brunswick, NJ. Job Responsibilities: + Under the direct supervision of the Nurse Manager of Clinical Research Center (CRC), you will be responsible for ... of Sites, Sponsors, and CROs across the research and clinical trials landscape. By blending deep subject matter expertise...plus. + Ability to work on 12 to 15 concurrent trials - must have strong organizational and prioritization… more
- Mount Sinai Health System (New York, NY)
- …preferred. + Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign ... 4. Conducts Root Cause Analysis investigations which include assessing need for focused review by departments, and/or clinical chairpersons for peer reviews. 5.… more
- Hackensack Meridian Health (Red Bank, NJ)
- …experience. **Licenses and Certifications Required:** + Current state Registered Nurse license. + Certified Clinical Documentation Specialist (CCDS) ... healthcare and serve as a leader of positive change. The ** Clinical Documentation Specialist RN** facilitates improvement in the overall quality, completeness… more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. c. Provides clinical information requested by the ... for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).… more
- Molina Healthcare (Yonkers, NY)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the… more
- MVP Health Care (Tarrytown, NY)
- …. The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This individual ... will make triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum...health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required + New York State license required… more
- Molina Healthcare (Yonkers, NY)
- …requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care ... for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation… more
Recent Jobs
-
RN - Psych Behavioral Health
- Yale New Haven Health (New Haven, CT)
-
Clinical Product Manager - Medical Device Safety & Usability
- Oracle (Concord, NH)
-
Senior Project Engineer - Avionics Test Engineering (Onsite)
- RTX Corporation (Cedar Rapids, IA)
-
Associate Manager, Brand Marketing
- NBC Universal (New York, NY)