is accurately reflected. This is accomplished by performing prospective, concurrent and retrospective review of various types...: Performs prospective, concurrent and retrospective review of various types of patient medical records from multiple settings...
authorization and concurrent review) as a Registered Nurse within a managed care organization desired. Experience... performance with regard to prior authorization, medical necessity determinations, concurrent review, retrospective review...
review. General Medical-Surgical nursing is sufficient to be relevant to the clinical areas addressed in most initial... and concurrent review within the guidelines of URAC, disability, workers compensation regulations, and state and federal requirements...
Below mentioned is the job description for your reference: Job Title: Clinical Review Nurse- Concurrent Review... necessity for an inpatient stay, the nurse is expected to send to a medical director for review. If an authorization is denied...
Below mentioned is the job description for your reference: Job Title: Clinical Review Nurse- Concurrent Review... director for review. If an authorization is denied the nurse will be expected to follow up with UM department (by phone/fax...
Medical Management - Concurrent Review Nurse- RN 145-2009 Tulsa, OK, USA Req #710 Monday, January 13, 2025... JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential coordination...
the utilization review nursing team for our Texas health plan. This role ensures compliance with state and federal.... Responsibilities: Essential Functions Supervise and provide guidance to the Utilization Review (UR) Nursing team, ensuring timely...
position to all audiences Performs other duties as assigned Position: UM Outpatient Clinical Review Nurse /Utilization... level of care, using applicable coverage documents and clinical guidelines Collects, documents, and maintains review...
a clinical retrospective review of services previously provided to determine if the level of care and services provided were... administered with quality, cost efficiency, and are within compliance. Performs a clinical review of post-care services...
for inpatient review and directs communication with the facility to elicit clinical information and facilitate discharge planning...Position Scope: Manages/Coordinates an active caseload of inpatient case management cases for Cigna. Uses clinical...
status Enter clinical review information into system for transmission to insurance companies for authorization Review...Responsible for utilization review work for emergency admissions and continued stay reviews Responsibilities Review...
We are seeking a Utilization Review Nurse to join one of Houston’s largest Independent Physician Associations... Utilization Review Nurse must live in the Houston area. The Utilization Review Nurse is responsible for ensuring quality, cost...
Description : The Professional Review Nurse provides analysis of medical services to determine appropriateness... licensure as a Registered Nurse in the state of employment with a minimum of 4 years clinical experience...
Health, visit us at https://www.baptistfirst.org. The RN – Utilization Review Nurse Manager shall manage the daily... Degree in Nursing, Master's degree preferred. Minimum 3-5 years’ hospital-based experience in concurrent utilization review...
The Utilization Review RN is responsible for utilization management and utilization review for prospective, concurrent... determination. The Utilization Review RN conducts prospective, concurrent and retrospective utilization review for inpatient...
in discharge. Documents all Avoidable Days in CANOPY system. Performs clinical review on admission and/or continued stay using...UPMC is hiring a part time Professional Care Manager for our Utilization Review department in Hanover! This is a part...
. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior.... In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial and concurrent...
The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical financial.... Strong critical thinking skills and the ability to perform clinical/chart review abstract information efficiently. Strong analytical...
Engagement Description Perform prospective, concurrent, and retrospective review of inpatient, outpatient, ambulatory... as: Registered Nurse-Review Analyst:...
a Full-Time Lead Utilization Review Nurse (RN) who will be responsible for partnering with the Director of Utilization... Management to oversee the daily operations of the department. This includes monitoring the activities of clinical and support...