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Millennium Physician Group
Overview
The specialist performs coding reviews and decision-making to validate provider documentation for clinical conditions. They are responsible for prospective, concurrent, and retrospective medical record reviews to ensure accurate severity of illness reporting.
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Compensation
Salary not listed
Posted
4 days ago
Village Care
The nurse will assess member needs and review healthcare services to ensure medical necessity and cost-effectiveness using evidence-based criteria. Responsibilities include collaborating with medical directors, managing denials, and supporting quality improvement initiatives.
$95,000 - $105,000 / YEAR
9 days ago
Kaiser Permanente
The Patient Care Coordinator RN is responsible for optimizing the quality and efficiency of care for hospitalized members through daily utilization and quality reviews, discharge planning, and care coordination. This involves collaborating with multidisciplinary teams to develop safe discharge plans and ensuring compliance with all relevant regulations to achieve desired utilization and quality outcomes.
2 months ago
AmTrust Financial Services, Inc.
The primary purpose is to provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider, and employer. Responsibilities include utilization review, pharmacy oversight, and care coordination while partnering with adjusters on a holistic approach for each claim.
$66,900 - $91,000 / YEAR
4 months ago
The primary purpose is to provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work by engaging the injured employee, provider, and employer. Responsibilities include utilization review, pharmacy oversight, and coordinating treatment while maximizing quality and cost-effectiveness of care.
Surgery Partners, Inc
The RN Utilization Review Coordinator performs prospective, concurrent, and post-discharge utilization reviews to ensure patient status, medical necessity, and compliance with regulations, while supporting accurate admission determinations and active denial management. This role also assists with discharge planning and contributes to utilization review reporting and performance improvement initiatives.
