to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial... and utilization review activity per department and medical center standards in a timely manner. Performs and documents accurate...
to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial... and utilization review activity per department and medical center standards in a timely manner. Performs and documents accurate...
health benefits plan. Performs admission and concurrent review to identify medical necessity, level of care...Utilization Management Nurse - Christiana Hospital FT Day Shift (Hours: 8 AM - 4:30 PM) Hybrid Newark...
Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the... review, b) care coordination, c) transition planning assessment and reassessment, d) implementation or oversight...
review systems for all pay sources to include admissions, continued stay, and concurrent and retrospective reviews..., and fee structures. Assists patients, families, physicians, and clinicians via telephone with clinical issues, problems...
, on a concurrent basis, the appropriateness, intensity, and timeliness of the level of care, diagnostic testing and clinical procedures..., quality and clinical risk issues and documentation completeness. The RN Registered Nurse Case Manager will develop...
based on an alpha split and then review clinical information provided by facilities to determine medical necessity when..., policies and nationally recognized clinal criteria for BSC Medicare line of business. Conduct clinical review of claims...
functions, including response to payor requests for concurrent and retrospective review information including Medicare... of assigned patients; develops plans of care and discharge plans, monitors all clinical activities, makes recommendations...
team to achieve optimal quality, clinical and resource outcomes. Works to provide a comprehensive range of services... or clinical care associated with and in accordance with standards of excellence established by Riverside Health system...
organizations, agencies and healthcare facilities. Conduct concurrent medical record review using specific indicators and criteria... resources to assist in achieving desired clinical outcomes within the desired time frame. Conducts review for appropriate...
Anticipated End Date: 2025-11-01 Position Title: Medical Management Clinician Associate - Licensed Practical Nurse... Clinician Associate is responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical...
Job Category: Support/Clinical Degree Level: Associate's Degree/College Diploma (±13 years... review, (b) care coordination, (c) transition-planning assessment and reassessment, (d) implementation or oversight...
information about this position. Coordinates utilization review activities for the purpose of monitoring standards of patient...: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Current Registered Nurse license issued by the state in which services...
States of America) Job Summary: Full-time- Days The Trauma Nurse Coordinator is a registered nurse who functions... under the direction of the Trauma Program Manager to coordinate clinical, operational, and performance improvement initiatives...
appropriate level for understanding Review the entire medical record for accuracy, and appropriate clinical treatment... experience and understanding of disease pathology to review chart/clinical information, ask appropriate questions, and identify...
, 8:00 a.m.–5:00 p.m. (40 hrs/week, No weekends or OT) Overview: Seeking an experienced Registered Nurse to review...Registered Nurse – Medical Claims Reviewer (AHCCCS) Location: Remote (Arizona Residents Only) Schedule: Monday–Friday...
Title: Registered Nurse, Care Management Orlando Health Lake Mary Hospital The NEW Orlando Health Lake Mary Hospital..., wireless and waterproof heart rate monitors for mom and baby, a smart board that integrates patient and nurse information...
· Concurrent review of medical records against pre-established criteria/quality initiatives · Develop and maintain collaborative...Quality Improvement Coordinator, Registered Nurse – Neuro Administration We’re looking for a Quality Improvement...
, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical... and a current state Registered Nurse license. 2. Grandfathered prior to April 1, 2015. Minimum 5 years post graduate...
: First Shift Title: Registered Nurse, Care Management Orlando Health Lake Mary Hospital The NEW Orlando Health Lake... that integrates patient and nurse information from Epic, WiFi, and televisions. These modern amenities ensure a comfortable...