review using current evidence-based clinical decision support criteria; Completes full assessment of plan of care... Patient Review Instrument (PRI) prior to admission as needed; Maintains appropriate documentation; Consults with the...
balance, continuous learning, and career development. Summary We are seeking a skilled Utilization Review Nurse to conduct... prior authorization, prospective, concurrent, and retrospective reviews for medical necessity and appropriateness...
balance, continuous learning, and career development. Summary We are seeking a skilled Utilization Review Nurse to conduct... prior authorization, prospective, concurrent, and retrospective reviews for medical necessity and appropriateness...
perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health... to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health...
perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health... to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health...
perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health... to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health...
perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health... to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health...
perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health... to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health...
to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards Performs prior authorization reviews related.... Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required. Knowledge of ABA services...
NORTH CAROLINA BEHAVIORAL HEALTH LICENSURE*** Position Purpose: Performs a clinical review and assesses care related..., during, and after services to ensure level of care and services are medically appropriate Performs prior authorization reviews related...
Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines... are medically appropriate Performs prior authorization reviews related to mental health and substance abuse to determine medical...
, and pharmacies. Escalates medical exception requests to nurse, pharmacist or physician on the utilization review clinical team when... clinical criteria. Makes approval recommendations on all services that meet clinical review criteria. Refers all cases...
spectrum disorder needs and clinical standards Performs prior authorization reviews related to BH to determine medical... health clinicians preferred. Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans...
JOB DESCRIPTION SUMMARY Reports to the Nurse Supervisor and assists in the process of health management and utilization review (UR). The... AND RESPONSIBILITIES Administrative Support Review all utilization requests and forward, research, and analyze to determine if clinical...
a day for concurrent review or 20 authorizations a day for prior authorization. Excellent attention to detail, critical... review and evaluation of members that require hospitalization and/or procedures providing prior authorizations...
a day for concurrent review or 20 authorizations a day for prior authorization. Excellent attention to detail, critical... review and evaluation of members that require hospitalization and/or procedures providing prior authorizations...
perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health..., during, and after services to ensure level of care and services are medically appropriate Performs prior authorization reviews related...
related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards Performs prior authorization... health clinicians preferred. Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans...
prior to procedure and post procedure * Ensures UR Coordinators and Clinical Coordinators identify, document... of professional leadership experience (i.e., charge nurse, team leader, preceptor, committee chair, etc.) Five (5) years clinical...
perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health... to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health...