Find clinical, allied health, care team, and healthcare operations openings using one smart search field across cities, regions, and employers.
Emory Healthcare
Overview
Conduct medical necessity reviews for inpatient and observation admissions using Milliman and Interqual guidelines to ensure appropriate status designation. Coordinate with physicians and payers to maximize reimbursement and reduce financial risk through timely communication and documentation.
Quick view →
Compensation
Salary not listed
Posted
9 days ago
UHS
The specialist is responsible for improving the quality and completeness of clinical documentation through concurrent and retrospective reviews of inpatient medical records. They collaborate with physicians and coders to ensure accurate reimbursement and reflect the true severity of patient illness.
15 days ago
21 days ago
Perform concurrent and retrospective reviews of inpatient medical records to ensure accurate documentation of patient severity and risk of mortality. Facilitate physician documentation to ensure compliant reimbursement and quality of care reporting.
29 days ago
Mission Regional Medical Center
The CDS Trainee conducts concurrent and retrospective reviews of inpatient medical records to ensure documentation reflects quality-of-care and reimbursement compliance. They collaborate with medical staff to facilitate accurate clinical documentation and evaluate admission criteria.
1 month ago
Molina Healthcare
The clinician is responsible for assessing service requests to ensure medical necessity, cost-effectiveness, and compliance with clinical guidelines and regulations. They collaborate with multidisciplinary teams and medical directors to facilitate appropriate care outcomes for members.
Children’s National Hospital
The Utilization Review RN is responsible for conducting preauthorization, initial, and concurrent clinical reviews for inpatient and home health services to ensure medical necessity. They coordinate care, manage resources, and facilitate discharge planning while maintaining compliance with regulatory standards and internal guidelines.
Responsible for preauthorization and concurrent review of inpatient, behavioral health, and home health services using standardized clinical criteria. Coordinates care, discharge planning, and resource management while maintaining communication with medical directors and clinical staff.
The clinician assesses service requests for medical necessity and compliance with clinical guidelines to ensure cost-effective member care. They collaborate with multidisciplinary teams and medical directors to manage prior authorizations and support the integrated delivery of care.
Adoration Home Health and Hospice
The Utilization Review Nurse processes authorization requests and clinical inquiries according to plan benefits and established guidelines, collaborating with internal teams like inpatient review nurses and Medical Directors to ensure timely determinations for medical services. Responsibilities include performing reviews for various services, consulting with Medical Directors when criteria are not met, and communicating decisions to providers and members.
2 months ago
KPC GLOBAL MEDICAL CENTERS INC.
The RN Case Manager reviews inpatients to determine admission and continued stay criteria, and is responsible for formulating discharge plans after interviewing patients and family members regarding their needs. This role involves collaboration with physicians, nursing, ancillary staff, and payers, along with documenting medical reviews in the QRS system for various financial classes.
$50 - $74 / HOUR
3 months ago
