. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the... will ensure compliance with the WellMed expectations for prospective, concurrent, retrospective and transition to out-patient care...
clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting... to assure timely progression of care and transitions. Documents discharge planning interventions and utilization review activity...
information about this position. Coordinates utilization review activities for the purpose of monitoring standards of patient...: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Licensure in the state of WV to practice as a Registered Nurse. 2. Obtain...
to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial... interventions and utilization review activity per department and medical center standards in a timely manner. Performs and documents...
UM activities as required based on local structure to include providing clinical updates to payers and/or external review... and transitions. Documents discharge planning interventions and utilization review activity per department and medical center...
nurse practitioners and physician assistants and nearly 100 locations in our network. Utilizing innovative clinical research... by the American Society of Clinical Oncology (ASCO) with a national Clinical Trials Participation Award, FCS offers patients...
and/or prospective/retrospective to the patient visit to determine opportunities to query physicians regarding essential clinical... 1.00 Required Reg Nurse (Single State) 1.00 Required RN - Multi-state Compact 1.00 Required Additional Licenses and Certifications...
departmental processes designed to oversee the medical review process for clinical appeals and par provider retrospective...Summary of Position Direct supervision of the Clinical Nurse Reviewer staff, oversee the clinical team...
of processes related to the concurrent review of the clinical documentation in the inpatient medical record of Optum 360 clients... Responsibilities: Provides expert level review of inpatient clinical records within 24-48 hours of admit; identifies gaps in clinical...
of processes related to the concurrent review of the clinical documentation in the inpatient medical record of Optum 360 clients... Responsibilities: Provides expert level review of inpatient clinical records within 24-48 hours of admit; identifies gaps in clinical...
and committees. Assist with retrospective reviews and preparation of appeals as indicated. Facilitate peer review activities... for assigned clinical outcomes, and present this data at the appropriate meetings as defined or needed. Serve as team member...
or University preferred. Three (3) to Five (5) years of clinical experience as a Registered Nurse (RN) in an acute care setting... Repayment Assistance Program The Clinical Effectiveness Coordinator will analyze and report on key clinical performance...
or University preferred. Three (3) to Five (5) years of clinical experience as a Registered Nurse (RN) in an acute care setting... Repayment Assistance Program The Clinical Effectiveness Coordinator will analyze and report on key clinical performance...
, and compliant. The Clinical Appeals and CDI Specialist provides nurse consultation services that consist of reviewing... in order to create educational strategies to ensure correct diagnosis code assignment by the client. Review clinical...
process. Our team members review medical record documentation and apply clinical criteria and guidelines to ensure... data collection. Collaborates with coding staff on retrospective medical record review for severity, accuracy...
nurse practitioners and physician assistants and nearly 100 locations in our network. Utilizing innovative clinical research... by the American Society of Clinical Oncology (ASCO) with a national Clinical Trials Participation Award, FCS offers patients...
within VHS and UHS Subsidies Job Description: Provides clinically based concurrent and retrospective review of inpatient.../Certification: Current RN license in the state in which they reside/practice if Registered Nurse. Other: Knowledge of age...
within VHS and UHS Subsidies Job Description: Provides clinically based concurrent and retrospective review of inpatient.../Certification: Current RN license in the state in which they reside/practice if Registered Nurse. Other: Knowledge of age...
. Qualifications: Required · Licensure as a Registered Nurse (RN), Massachusetts · Three years of recent clinical.... Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the...
as an RN Appeals Analyst, you will research the substance of complex appeal or retrospective review requests including pre-pay... and post-payment review appeal requests. Provide thorough clinical review or benefit analysis to determine if the requested...