- MVP Health Care (Schenectady, NY)
- …requires innovative thinking and continuous improvement. To achieve this, we're looking for a ** Leader , Concurrent Review ** to join #TeamMVP. If you have a ... review . + 2+ years of supervisory experience + Strong understanding of concurrent review , sub-acute care, rehabilitation, and skilled nursing services. +… more
- Datavant (Augusta, ME)
- …(prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time ( concurrent review ). You will manage a cross-functional team of product ... the product vision, strategy, and roadmap for the Prospective Suspecting and Concurrent Review solutions within Datavant's Clinical Insights Platform suite. +… more
- Trinity Health (Maywood, IL)
- …of procedural cases and submitting/monitoring post acute authorization status. Admission and Concurrent Case Review : + Uses approved criteria for admission and ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Utilization Review - RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal Hospitals.… more
- Nuvance Health (Danbury, CT)
- …integration of denials prevention operations such as prior authorization, initial and concurrent review , and denials management into other internal and external ... departments to ensure compliance with regulatory requirements and optimize the utilization review process. *Responsibilities:* * Lead and manage daily operations… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …reduction - focusing on 30 days, all causes * Assist with the segmentation of concurrent review offerings into Medicare / Medicaid / Commercial Payors, as needed ... be a key member of the medical staff and take on the role as leader of the Hospital's utilization review /management committee, which is charged with adhering to… more
- Mohawk Valley Health System (Utica, NY)
- …the application of the 2nd Midnight across payor types (CMS regulation). + Perform concurrent review and escalation of cases not meeting criteria. + Provide ... (RAC's). + Assist with mitigating barriers to discharge and care progression. + Perform concurrent review of cases greater than 4 days or the assigned/estimated… more
- Nuvance Health (Danbury, CT)
- …level of care. Develop clinical criteria and guidelines for efficient UR processes. * * Concurrent Review :* Oversee the concurrent review process, ... *Description* *Summary:*The *System Care Coordination Leader * will serve as a pivotal force in...and contribute to the UR committee meetings. * *Utilization Review (UR):* * *Proactive UR:* Lead a… more
- CareFirst (Baltimore, MD)
- …Navigator RNs. Utilizes MCG to act as a resource for the nurses to conduct concurrent review for medical necessity and appropriate level of care for Commercial ... Management. + Oversees associates conducting care coordination activities including concurrent review utilizing MCG. Collaborates with CareFirst medical… more
- CVS Health (CT)
- …ensuring timely and consistent responses to members and providers related to precertification, concurrent review , and appeal request. The medical director is a ... * Utilization management - The medical director will perform concurrent and prior authorization reviews with peer to peer...medical director will participate in and be able to lead daily rounds. **Required Qualifications:** Minimum 3-5 years of… more
- Cedars-Sinai (Beverly Hills, CA)
- …assessing their needs, coordinating care, communicating with health plans (including concurrent review , which assists the hospitalist/specialist and case manager ... Little More About What You Will be Doing** The Lead Case Manager will assist in the daily operations...and case manager assigned to the SNF's for continued review and follow up. + Authorize all appropriate services… more