- Dignity Health (Rancho Cordova, CA)
- …CA** **.** You will be responsible for monitoring Dignity Health Medical Foundation inpatient admissions and concurrent review for appropriate level of ... - Clear and current CA RN license. **Preferred Qualifications:** - Concurrent review , prior authorizations for medical determination preferred. - Bachelors… more
- Dignity Health (Woodland, CA)
- …Summary:** This position is responsible for monitoring Dignity Health Medical Foundation inpatient admissions and concurrent review for appropriate level ... - Clear and current CA RN license. **Preferred Qualifications:** - Concurrent review prior authorizations for medical determination, preferred. - Bachelors… more
- Martin's Point Health Care (Portland, ME)
- …and outpatient medical services, notification of emergent hospital admissions, completes inpatient concurrent review , establishes discharge plans, ... Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for...+ Review prior authorization requests (prior authorization, concurrent review , and retrospective review )… more
- Molina Healthcare (NM)
- …health Previous experience with MCG guidelines. At least 2 years of experience with inpatient concurrent review , prior authorization and managed care; Acute ... .** JOB DESCRIPTION Job Summary Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying that services… more
- Trinity Health (Columbus, OH)
- …Coordinator and other operational departments regarding case management issues. + Conducts inpatient concurrent review . + Documents and communicates to ... analysis, audit, provider relations and more. **Position Purpose:** The RN Case Manager MCHP is responsible for the coordination...with the Plan's UM and QM Program and the review of the Plan's Medical Management Plan. **What we… 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 ... for overall System Case Mix Index. Job Duties The RN CDI Specialist acts as a liaison between the...Minimum of 3 years-Nursing (Required) Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania… 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 ... weekly; Dayshift; Monday through Friday. Candidates must hold a Registered Nurse license in Pennsylvania or a...or a Multistate License. A minimum of 3 years RN work experience is required; BSN is strongly preferred.… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …**What you'll do:** + Performs medical necessity review that includes inpatient review , concurrent review , benefit advisory/prior authorization, ... or four (4) years' work experience (REQUIRED) + Current State Licensure as a registered nurse (REQUIRED) + Three (3) years of clinical experience (REQUIRED) +… more
- Veterans Affairs, Veterans Health Administration (Fort Meade, SD)
- …and completeness of clinical documentation. Inpatient CDI focuses on the concurrent review of patient records with an emphasis on improving documentation ... encounters through retrospective, ideally prior to coding and billing, review of outpatient encounters and extensive provider education. Applies comprehensive… more
- Avera (Sioux Falls, SD)
- …cause undue hardship to the employer. **Required Education, License/Certification, or Work Experience:** + Registered Nurse ( RN ) - Board of Nursing An active ... clinical guidelines for level of care reviews (first level review ), and refers cases to the internal or external...Maintains knowledge by payer for level of care requirements, inpatient only list, concurrent and retrospective authorization… more
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