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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
4 days ago
Emory Healthcare
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.
Salary not listed
9 days ago
Vantage Search Group
Provides comprehensive discharge planning services for inpatients and emergency department patients to ensure safe and timely transitions to the next level of care. Collaborates with multidisciplinary teams and third-party payers to coordinate medical equipment, referrals, and authorizations.
$34 - $59 / HOUR
11 days ago
Cedars-Sinai
The Case Manager coordinates patient care from admission through discharge, ensuring medical necessity and cost-effectiveness. Key duties include conducting initial assessments, collaborating with hospitalists on disposition planning, and managing transitions to various care settings.
$47 - $76 / HOUR
14 days ago
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
23 days ago
SolutionHealth
The specialist evaluates medical acuity to ensure appropriate level of care orders and documentation to facilitate insurance coverage and prevent denials. They also review appeal options for medical necessity denials and ensure compliance with CMS and commercial insurance guidelines.
25 days ago
Neuropsychiatric Hospitals
The Utilization Review Nurse will coordinate and support the hospital’s Utilization Review and Case Management program to ensure appropriate level of care, efficient resource use, and timely discharge planning. This involves reviewing patient charts, communicating with payors, and collaborating with multidisciplinary teams to support positive patient outcomes.
3 months ago
The RN Case Manager coordinates patient care within an acute hospital setting, including managing discharge planning and transitions. They perform medical necessity reviews and collaborate with interdisciplinary teams to act as a clinical resource.
$41 - $63 / HOUR
