- Centene Corporation (Cheyenne, WY)
- …with interdepartmental teams on projects within utilization management as part of the clinical review team + Partners and works with Medical Affairs and/or ... based on diagnoses, prognoses, resources, and/or preferences + Manages and maintains concurrent review findings, discharge plans, and actions taken on member… more
- InnovaCare (San Juan, PR)
- …customer focus to the business. MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the ... compliance with the Plan's SNP policies and MOC requirements. Clinical staff who do not complete the required annual...within forty-eight (48) hours of having performed the first concurrent review of notified admission cases.4. On… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …in a UM team within managed care setting. + 3+ years experience in clinical nurse setting preferred. + TPA Experience preferred. About At Brighton Health ... BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This position reports to the… more
- RWJBarnabas Health (Jersey City, NJ)
- Nurse Midwife(FT) Days- MMG Concurrent -Jersey CityReq #:0000106025 Category: Nurse Midwife Status:Full-Time Shift:Day Facility:Jersey City Medical Center ... Department:MMG Concurrent Location: Jersey City Medical Center, 355 Grand Street,...Street, Jersey CIty, NJ 07302 Job Overview- The Certified Nurse Midwife position provides antepartum, intrapartum, postpartum, neonatal and… more
- Northwell Health (Riverhead, NY)
- … clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests clarification ... of clinical documentation from the physician(s) on a ...date. *Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications… more
- Montana State University-Northern (Havre, MT)
- …is ten. The CRRN is responsible for the students and must have not have concurrent clinical responsibilities. The CRRN may also be assigned to monitor students ... Clinical Resource Registered Nurse (CRRN) part-time...position including any supplementary documentation and questions you should review before applying for the opening. To apply for… more
- HCA Healthcare (Corpus Christi, TX)
- …Corpus Christi Medical Center Bay Area! **Job Summary and Qualifications** The Review Nurse Clinical Reviewer position encompasses multiple responsibilities ... **Are you passionate about delivering patient-centered care?** Submit your application for Registered Nurse Clinical Reviewer position and spend more time at the… more
- Geisinger (Wilkes-Barre, 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 ... a rewarding, lasting career with impact. Job Duties The Clinical Documentation Improvement Program (CDI) is designed to improve...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
- HCA Healthcare (Corpus Christi, TX)
- …your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer PRN opening. We review all applications. Qualified candidates will be ... **Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer PRN you want in...including Core Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews… more
- HCA Healthcare (Houston, TX)
- **Description** **Introduction** **Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your current role? We invest in ... HCA Houston Healthcare Northwest!** **Job Summary and Qualifications** **The Quality Review Nurse position encompasses multiple responsibilities including Core… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of the Utilization Review Team and ... reviewing claims disputes and retrospective requests for services requiring clinical review prior to payment. The Utilization... review prior to payment. The Utilization Review Nurse will use appropriate governmental policies… more
- Beth Israel Lahey Health (Burlington, MA)
- …being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for ... duties as required and directed. **Qualifications:** Required Licensure as a Registered Nurse (RN), Massachusetts Three years of recent clinical or utilization… more
- CDPHP (Albany, NY)
- …The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes ... completing inpatient level of care reviews, post-acute care initial and concurrent reviews for acute and subacute rehabilitation, transportation and DME requests.… more
- Glens Falls Hospital (Glens Falls, NY)
- …hours per week, can be foundhere. **Job:** **Nursing - Case Management* **Title:** *Registered Nurse - Utilization Review Nurse - Care Management (Sign-On ... * * *How You Will Fulfill Your Potential* *Responsibilities* * Conducts concurrent and retrospective review (s) utilizing InterQual (IQ) medical necessity… more
- Travelers Insurance Company (Buffalo, NY)
- …Imagine loving what you do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual base salary range provided ... the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective, … more
- University of Utah Health (Salt Lake City, UT)
- …and continued stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient ... expected cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- LA Care Health Plan (Los Angeles, CA)
- …prospective, concurrent , post-service and retrospective claim medical review processes. Utilizing considerable clinical judgement, independent analysis, ... Utilization Management Nurse Specialist LVN II Job Category: Clinical...inpatient setting. Performs telephonic and/or on site admission and concurrent review , and collaborates with onsite staff,… more
- Baystate Health (Greenfield, MA)
- …to **Baystate Franklin Medical Center** is looking for a **Per Diem** **Registered Nurse (RN), Case Manager** to join our Hospital Case Management team in ... **SCHEDULE:** + Per Diem **MINIMUM QUALIFICATIONS:** + MA Registered Nurse License + American Heart Association BLS CPR +...Association BLS CPR + Minimum 3 years acute care clinical nursing experience + Case Management experience **LOCATION** :… more
- LA Care Health Plan (Los Angeles, CA)
- …in any inpatient setting. Performs telephonic and/or on site admission and concurrent review , and collaborates with onsite staff, physicians, providers, ... Utilization Management Nurse Specialist RN II Job Category: Clinical...workplace environment. Perform telephonic and/or on site admission and concurrent review , and collaborates with onsite staff,… more
- HCA Healthcare (Las Vegas, NV)
- …clinical data compiled by hospital medical records for the purpose of admission/ concurrent review for Medicare and self-pay patients + Identifies potential ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...and apply today! + You will be performing admission review to determine appropriateness and medical necessity based on… more