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AltaMed
Overview
The LVN Case Manager provides daily care coordination and concurrent review for patients in hospitals or skilled nursing facilities. They collaborate with an interdisciplinary team to manage patient care transitions and identify specific case management needs.
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Compensation
$33 - $41 / HOUR
Posted
3 days ago
Centene Corporation
Conducts clinical reviews and prior authorizations for mental health and substance abuse services to ensure medical appropriateness. Monitors inpatient stays and collaborates with providers and medical directors to optimize care quality and efficiency.
$27 - $49 / HOUR
4 days ago
L.A. Care Health Plan
The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary referrals, ensuring timely determination and notification of referral statuses, and generates necessary approval or denial communications. This role also involves performing telephonic and/or onsite admission and concurrent review, collaborating on discharge plans, and monitoring inpatient admissions.
$88,854 - $142,166 / YEAR
7 days ago
UHS
The Utilization Review Coordinator performs admission and concurrent reviews of patients to ensure cost-effective, high-quality care. They collaborate with physicians and social services to maintain documentation and conduct psychosocial assessments.
Salary not listed
24 days ago
The Utilization Review Coordinator performs admission and concurrent reviews of patients to ensure high-quality, cost-effective care. Responsibilities include conducting psychosocial assessments, coordinating with community agencies, and collaborating with the treatment team on patient interventions.
LSMA Management Inc
The Concurrent Care Management LVN supports inpatient and post-acute care coordination and concurrent review activities to ensure medically appropriate and cost-effective utilization of healthcare services for members of a California MSO. This role involves monitoring utilization, supporting discharge planning, facilitating transitions of care, and coordinating services across the continuum in collaboration with various healthcare providers.
$35 - $40 / HOUR
28 days ago
UnitedHealth Group
Coordinate long-term care needs for patients by assessing, planning, and implementing individualized care strategies. Act as a single point of contact to manage care plans and advocate for patients to ensure they receive appropriate health and social services.
$29 - $52 / HOUR
29 days ago
The UR Coordinator manages communications between the treatment team and insurance companies to secure prior authorizations and concurrent review extensions. They analyze clinical documentation for medical necessity and track authorization statuses and appeals within the electronic system.
1 month ago
Elevance Health
The Psychologist Reviewer collaborates with providers and Medical Directors to determine the appropriateness of care levels based on medical necessity criteria. They also conduct pre-certification, concurrent reviews, and appeals for behavioral health services while mentoring care management staff.
$93,120 - $167,616 / YEAR
Millcreek of Magee
Provide administrative support to the Utilization department by performing pre-certifications and negotiating continued stays with third-party payers. Coordinate discharge planning with clinical teams and assist physicians with peer review data and scheduling.
Sanctuary Recovery Centers
Manage initial and concurrent authorizations for behavioral health services while ensuring compliance with AHCCCS guidelines and medical necessity criteria. Coordinate with clinical staff and payers to maintain accurate records in the EHR and prevent gaps in coverage.
WVU Medicine
This role coordinates quality improvement, assurance, and patient safety activities to maintain and enhance patient care services. Responsibilities include performing quality review studies, analyzing and reporting data, leading performance initiatives, and investigating patient complaints.
Acadia
The specialist coordinates and assesses the inpatient census to ensure appropriate healthcare service needs and medical necessity. They act as a liaison between managed care organizations and clinical staff to manage authorizations and reimbursement requirements.
$33 - $60 / HOUR
The coordinator monitors treatment activities for mental health and dual diagnosis patients to ensure quality care and continuity. They perform concurrent reviews for inpatient and outpatient services and manage the appeals process until final decisions are reached.
Clever Care Health Plan
Perform clinical reviews of authorization requests to determine medical necessity based on established criteria and regulatory requirements. Communicate decisions to providers and members while ensuring compliance with CMS and state turnaround times.
$35 - $43 / HOUR
MALVERN INSTITUTE FOR PSYCHIATRIC & ALCOHOLIC STUDIES
Conduct continued stay reviews of medical records using pre-established criteria to secure payment certifications from third-party payers. Coordinate reviews and appeals while maintaining accurate work logs and communicating authorization details to the treatment team.
$28 - $35 / HOUR
PROGRESSIONS INC
Conduct continued stay reviews of medical records using pre-established criteria to secure payment certifications from third-party payers. Coordinate reviews and appeals while maintaining accurate documentation and communication with treatment teams and insurance carriers.
NeueHealth
The Concurrent Utilization Review Nurse conducts real-time clinical reviews to ensure the medical necessity and appropriateness of healthcare services. They also coordinate with healthcare providers and the Medical Director to facilitate care transitions and manage authorization requests.
$26 - $40 / HOUR
The Utilization Management Specialist manages communication between the treatment team and insurance agencies to secure prior authorizations and concurrent reviews. They also coordinate treatment review meetings and maintain accurate medical records for patient stays.
Regal Medical Group
This role supports the management process for all hospital and skilled nursing admissions, concurrent review, and discharge planning by ensuring timely and accurate information is provided to administrative teams, hospitalists, and care managers. Key duties involve anticipating customer needs, acting as a liaison between various healthcare providers, and maintaining strict patient confidentiality.
$25 / HOUR
2 months ago
