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Gainwell Technologies LLC
Overview
The Nurse Reviewer will perform clinical reviews to assess the appropriateness of care based on medical record documentation. This includes documenting findings, determining approvals, and assisting in training new Nurse Reviewers.
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Compensation
$65,000 - $75,000 / YEAR
Posted
3 days ago
Keck Medicine of USC
Facilitates discharge planning and throughput by coordinating post-acute services and communicating plans to patients and families. Supports the ambulatory care manager in managing complex case loads and ensuring cost-effective, quality health outcomes.
$29 - $45 / HOUR
4 days ago
University of Southern California
Provides support to the Case Management team to facilitate discharge planning and ensure appropriate patient throughput. Coordinates post-acute services and collaborates with interdisciplinary teams to promote cost-effective, quality health outcomes.
NeueHealth
The Utilization Management Nurse evaluates and processes prior authorization requests for medical procedures, medications, and services to ensure clinical appropriateness. They also collaborate with medical directors and healthcare providers to facilitate coverage decisions and maintain compliance with regulatory standards.
$74,260 - $111,391 / YEAR
5 days ago
The Utilization Review Nurse will conduct reviews for medical necessity and appropriateness of services, ensuring compliance with clinical criteria and policies. This includes engaging with providers, documenting findings, and assisting in training new nurses.
$65,000 - $78,000 / YEAR
6 days ago
Duke Health
The Licensed Clinical Social Worker manages a caseload to provide psychosocial assessments, crisis intervention, and discharge planning for inpatient surgery patients. They ensure compliance with regulatory standards while coordinating care transitions across the health system.
Salary not listed
8 days ago
The Licensed Clinical Social Worker manages a caseload to provide psychosocial assessments, crisis intervention, and discharge planning for inpatient surgery patients. They ensure compliance with regulatory standards while coordinating care transitions and collaborating with multidisciplinary teams.
Duke Careers
The Licensed Clinical Social Worker manages a caseload to provide psychosocial assessments, crisis intervention, and comprehensive discharge planning. They collaborate with multidisciplinary teams to ensure safe care transitions and compliance with regulatory standards.
14 days ago
The Licensed Clinical Social Worker manages a caseload to provide psychosocial assessments, crisis intervention, and discharge planning for inpatient surgery patients. They collaborate with multidisciplinary teams to ensure safe care transitions and compliance with regulatory standards.
Access Healthcare Staffing & Recruitment
The Utilization Review Nurse evaluates patient admissions to ensure medical necessity and appropriate resource utilization. They analyze medical records to verify that care aligns with established clinical and regulatory standards.
$40 - $63 / HOUR
22 days ago
Facilitates the transition of patients from hospital to home or post-acute care by coordinating with case managers and social workers. Manages non-clinical discharge aspects, performs post-discharge follow-up calls, and ensures continuity of care through resource connection.
$28 - $48 / HOUR
28 days ago
Emergent Holdings
The RN Case Manager develops and implements individualized treatment plans for members with complex health conditions via telephonic assessments. They coordinate internal and external resources to optimize health outcomes and ensure cost-effective delivery of healthcare benefits.
1 month ago
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.
Luminis Health
The Case Manager coordinates patient care to ensure safe and timely transitions across the healthcare continuum using evidence-based guidelines. Responsibilities include assessing patient needs, managing observation stays, and developing comprehensive transition plans for post-acute care.
$35 - $50 / HOUR
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
Facilitates the transition of patients from hospital to home or post-acute care by coordinating with case managers and social workers. Manages non-clinical discharge aspects, performs post-discharge follow-up calls, and ensures continuity of care.
Facilitates patient discharge planning and transitions of care by coordinating with case managers, social workers, and post-acute providers. Manages non-clinical discharge aspects, performs post-discharge follow-up calls, and ensures continuity of care through appropriate resource connection.
RADcube - A NLogix Company
Coordinate patient care and transitions in collaboration with multidisciplinary clinical teams to ensure appropriate resource utilization. Perform clinical assessments, discharge planning, and collaborate with third-party payers for service coverage.
Overlake Medical Center & Clinics
The Case Manager coordinates the assessment, planning, and implementation of care to ensure safe and sustainable discharge from the inpatient setting. They collaborate with the healthcare team to provide quality, cost-effective care while facilitating informed decision-making for patients.
$52 - $78 / HOUR
