and maintenance of high quality care through the analysis, review, and evaluation of clinical criteria as it relates to patient.... Managing and effectively utilizing insurance benefits through timely prospective, concurrent, and retrospective review...
and thereafter continuing stay reviews for all hospitalized patients Facilitates utilization review concurrent with decisions... and accreditation standards. The RN Utilization Specialist (RNUS) is an experienced registered professional nurse with extensive...
INPATIENT AND PHP PRIOR AUTHORIZATIONS. Position Purpose: Performs a clinical review and assesses care related to mental... Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs...
for all hospitalized patients Facilitates utilization review concurrent with decisions on hospitalization and may perform duties in the... Career Areas Growth and Expansion RN Utilization Specialist-Utilization Review Part Time Days Location Palos Heights...
, coordination, and follow-up of all concurrent and retrospective inpatient clinical denials. The Denial Review Coordinator... Experience And Skills Speaks, reads and writes English 5 years of clinical nurse experience 2 years of Case Management...
by utilizing Milliman and Interqual Guidelines in conjunction with a review of the patient chart, clinical judgement... by criteria guidelines, patient presentation, and clinical nursing judgement. In addition, concurrent reviews will be completed...
in conjunction with a review of the patient chart, clinical judgement, and discussions with the attending physician and/or physician... by ensuring criteria guidelines applied are addressed in the clinical review. The UR Specialist is responsible for timely...
(prior authorization/concurrent review) in an insurance company/managed care organization, preferably in Medicare. Working... of UM Nurses, UM Technicians and staff members within Utilization Management. Responsibilities include providing clinical...
concurrent information that includes patient status, treatment, and anticipated discharge Provide clinical information...Job Description: Responsibilities Utilization Review Director Opportunity - HRI Hospital is seeking a Director...
concurrent information that includes patient status, treatment, and anticipated discharge Provide clinical information...Job Description: Responsibilities Utilization Review Director Opportunity - HRI Hospital is seeking a Director...
SUMMARY: The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate use.... Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity...
SUMMARY: The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate use.... Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity...
SUMMARY: The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate use.... Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity...
SUMMARY: The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate use.... Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity...
SUMMARY: The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate use.... Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity...
Job Requirements POSITION SUMMARY The Utilization Review (UR) nurse performs medical necessity reviews on all payer... in appropriate reviews. The UR Nurse utilizes advanced clinical skills to facilitate the provision of care including the appropriate...
*** ***CANDIDATE WILL WORK UP TO 4 HOLIDAYS A YEAR WITH THIS ROLE*** Position Purpose: Performs a clinical review and assesses care... Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs...
admitted to acute level of care. Conducts daily concurrent clinical reviews for utilization/quality management activities...Requisition ID 40183 Department Clinical Resource Management Location Escondido, California Union CNA...
and maintenance of high quality care through the analysis, review, and evaluation of clinical criteria as it relates to patient.... Managing and effectively utilizing insurance benefits through timely prospective, concurrent, and retrospective review...
and maintenance of high quality care through the analysis, review, and evaluation of clinical criteria as it relates to patient.... Managing and effectively utilizing insurance benefits through timely prospective, concurrent, and retrospective review...