perspective on workplace flexibility. Must have RN compact licensur Position Purpose: Performs clinical reviews... needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services...
and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance... with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices...
Optum CA is seeking a Claims Review Manager RN to join our team in San Diego, CA. Optum is a clinician-led care... be an integral part of our vision to make healthcare better for everyone. At Optum, you’ll have the clinical resources, data...
Optum CA is seeking a Claims Review Manager RN to join our team in San Diego, CA. Optum is a clinician-led care... be an integral part of our vision to make healthcare better for everyone. At Optum, you’ll have the clinical resources, data...
reimbursement, through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting... clinical experience in a psychiatric or mental health setting. Licensure: RN, LCSW, MFT, or MSW degree. Additional...
reimbursement, through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting... clinical experience in a psychiatric or mental health setting. Licensure: RN, LCSW, MFT, or MSW degree. Additional...
be while Caring. Connecting. Growing together. The Regulatory Adherence Utilization Management Sr. Clinical Quality RN... and/or clinical appeals and grievance reviews Physical & Mental Requirements: Ability to push or pull heavy objects...
be while Caring. Connecting. Growing together. The Regulatory Adherence Utilization Management Sr. Clinical Quality RN... and/or clinical appeals and grievance reviews Physical & Mental Requirements: Ability to push or pull heavy objects...
Documentation Specialists as well as Clinical Support Specialists. EDUCATION/CERTIFICATION: RN degree in Nursing from an NLN... department including two clinical documentation specialists and two clinical support specialists. Critical review and timely...
, Utilize InterQual Criteria, Utilize Milliman Guidelines, Appeals and Denials, Concurrent Review, Continued Stay Reviews... responsibilities include care coordination, and discharge planning Open to MSW Care Manager (& have EITHER Associate clinical...
, and educating the patient and caregivers as well as the nursing staff. She/he is a clinician, educator, investigator, consultant..., and leader. She/he makes clinical judgments based upon a synthesis of current research, concepts, principles, theories...