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Concurrent Review Nurse I Jobs

Bh Clinician - (Concurrent Review-Commercial)
By Horizon Blue Cross Blue Shield of New Jersey At , Newark, 07105 $67,100 - $89,880 a year
Prefers working knowledge of case/care management principles.
Prefers working knowledge of principles of utilization management.
Prefers basic knowledge of health care contracts and benefit eligibility requirements.
Encourages member participation and compliance in the behavioral health case/disease management program efforts.
Completes other assigned functions as requested by management.
Behavioral health experience, preferably in a managed care setting, strongly preferred
Credit Review Analyst I
By Global Payments At , Jeffersonville $45,760 - $50,000 a year
Prepare spreadsheets and detailed written reports to be presented to management.
Skills / Knowledge - Learns to use professional concepts. Applies company policies and procedures to resolve routine issues.
What Are Our Desired Skills and Capabilities?
Demonstrate good listening, interpersonal and team working skills.
Typically no related experience required
Business and consumer credit and exposure analysis skills.
Medical Authorization Assistant (Concurrent Review)
By CalOptima At , Orange, 92868
Concurrent Review and Utilization Management experience.
Receives inpatient requests via fax, phone or electronically and enters data of new case information into the medical management system.
2 years of experience in a health care or managed care setting required.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Previous medical billing and coding experience.
Certified Medical Assistant (CMA) certification.
Concurrent Review Nurse, Rn - 23-246
By Hill Physicians Medical Group At , Sacramento

We’re delighted you’re considering joining us!

Physician, Inpatient Concurrent Review (Pt/Remote) (Ur Exp. Not Req'd)
By CorroHealth At , Remote From $100 an hour
Quality of life with a remote predictable part-time schedule*
Comprehensive training and education program
You have the ability to work remotely in a comfortable environment
MD or DO degree with strong acute care clinical knowledge
Adult Internal Medicine, Emergency Medicine, Hospitalist, Nephrology, Surgeon or Infectious Disease; Board certification (preferred)
Working knowledge of hospitals’ EMR
Concurrent Review Nurse-( Auditor)- Metro, East, Northeast
By MMM Holdings At , San Juan
One to three years experience in utilization management or health services setting preferred.
Five years clinical acute care hospital experience; ICU, Emergency Medicine Department, Medical / Surgical Department.
Must have ability to work as a team player with excellent verbal and written communication skills.
Familiarity with State Federal Governmental regulations and national accrediting agency requirement preferred (CMS/NCQA or regulatory agencies).
Performs tasks requiring independent knowledge judgment in addition to instructions and procedures provided.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Specialist I, Documentation Review I
By SitusAMC At , Saint Petersburg, Fl $46,800 - $60,000 a year

SitusAMC is where the best and most passionate people come to transform our client’s businesses and their own careers. Whether you’re a real estate veteran, a passionate technologist, or looking to ...

Concurrent Nurse Reviewer, Facility Utilization Review Unit
By Hawaii Medical Service Association At , Honolulu, 96814, Hi
Two years clinical care experience or case management or related experience.
Provide appropriate consultation and referral to Case Management or QUEST Integration program as appropriate.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
Knowledge of the appropriate protocol to be followed for a given diagnosis and the normative values of medical tests and procedures.
Good communication skills both verbally and written.
Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, and Outlook.
Clinical Review Nurse I
By Elevance Health At Hingham, MA, United States
Medicare Part B Appeals experience preferred.
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider grievances and appeals.
Generates appropriate written correspondence to providers, members, and regulatory entities.
Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
Adapts to a wide variety of medical review topics in Part B appeals.
Clinical Review Nurse I
By Elevance Health At Atlanta, GA, United States
Medicare Part B Appeals experience preferred.
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider grievances and appeals.
Generates appropriate written correspondence to providers, members, and regulatory entities.
Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
Adapts to a wide variety of medical review topics in Part B appeals.
Coordinator I, Ongoing Review
By Advarra At United States
Escalates any customer or timeline issues to management
Associates Degree or equivalent combination of education and/or experience
Conducts an administrative review of Protocol/site review and termination submissions by reading, reviewing, and understanding requirements and all supporting documentation
Two (2) years of experience in an office environment (preferably in a regulated industry)
Must have high level of attention to detail, accuracy and thoroughness; Problem solving skills
Excellent interpersonal skills to work professionally and effectively with others and provide high levels of customer service
Credit Review Buyback Analyst I
By GM Financial At , Fort Worth, 76102, Tx
Ability to understand GM Financials business, apply knowledge and critical thinking skills in day-to-day problems and solutions
Manage the recourse process by monitoring accounts placed on recourse and escalating them as buybacks when a trigger is breached
Knowledge of consumer credit preferred
Excellent verbal, written and communication skills
0-2 years of relevant experience required
Hybrid model opportunity in Fort Worth, TX: Potential to work 3 days remote and 2 days onsite.
Review & Appeals Specialist I
By National Commission on Certification of Physician Assistants (NCCPA) At Johns Creek, GA, United States
Your highly developed time management skills, systematic approach to organization/planning and keen attention to detail.
Maintain ongoing knowledge regarding NCCPA organizational policies, departmental policies, standard operating procedures, operational guidelines, business rules, reports and audit tools.
Your proven analytical approach and proactive problem-solving skills that identify and recommend solutions to the determined issues.
Your excellent written and verbal communications skills with a proficiency in diplomacy and confidentiality.
Your proven ability to manage competing priorities and accomplishing tasks within the agreed upon timeframe.
At least two years of professional experience in business, healthcare, appeals & grievances, state medical board or legal field.
Project Review Analyst I
By Newrez LLC At Fort Washington, PA, United States
Completes additional responsibilities as assigned by Management Team
Manage the Project Review team mailbox including review requests, inquiries and scenarios
Three (3) or more years of mortgage industry experience required
Prior Condo Project Processing/Mortgage eligibility experience required
Co-op documentation review and analysis experience a plus
Excellent verbal and written communication skills
Part Time Concurrent Review Nurse Rn -Remote
By Florida Blue At , $64,800 - $81,000 a year
Experience with the Healthcare industry and Managed Care
Experience in MS Word and Excel
 Income protection benefits: life insurance, Short- and long-term disability programs;
 Additional voluntary benefits available; and
Current RN - Registered Nurse - State Licensure And/Or Compact State Licensure Florida
Occasional travel within the State of Florida
Concurrent Review Cooridnators Jobs
By NTT DATA At , San Francisco, 94105, Ca $24.05 - $28.00 an hour
Strong organization, time management and project management skills and multi-tasking abilities.
Research utilization management requests using a variety of resources including SFHP evidence of coverage, policies and procedures, and electronic resources.
Provide administrative and clerical support for utilization management activities.
Coordinate activities with the other members of the Clinical Operations Management departments and the company.
Experience in an HMO or experience in a managed care setting preferred.
Knowledge and application of English grammar including composition, editing and proofreading skills.
Supervisor, Concurrent Review Jobs
By MJHS At , New York, Ny $101,503 - $126,879 a year
Sign-on Bonuses OR Student Loan Assistance for clinical staff
FREE Online RN to BSN and MSN degree programs!
Tuition Reimbursement for all full and part-time staff
Dependent Tuition Reimbursement for clinical staff!
Affordable medical, dental and vision coverage for employee and family members
Two retirement plans! 403(b) AND Employer Paid Pension
Bh Clinician - Concurrent Review
By Horizon Blue Cross Blue Shield of New Jersey At , Hopewell, Nj $67,100 - $89,880 a year
Prefers working knowledge of case/care management principles.
Prefers working knowledge of principles of utilization management.
Prefers basic knowledge of health care contracts and benefit eligibility requirements.
Encourages member participation and compliance in the behavioral health case/disease management program efforts.
Completes other assigned functions as requested by management.
Behavioral health experience, preferably in a managed care setting, strongly preferred.
Loan Review Analyst I
By Global Credit Union At , Glendale, 85306, Az $63,233 - $101,804 a year
Responsible for processing remote deposit capture annual reviews.
Maintains in-depth knowledge of NCUA regulations, credit union policies and procedures as they relate to commercial lending.
Voluntary cash benefits for accident, hospitalization and critical illness
Click here to view Global’s comprehensive Benefits Programs.
Perform annual loan reviews to include global analysis of borrower and guarantors on non-complex relationships.
Responsible for processing the due on demand lines of credit annual reviews.
Concurrent Review Nurse Jobs
By University HealthCare Alliance At , Newark, 94560, Ca $49.59 - $65.71 an hour
Excellent communication, organizational and time management skills with the ability to meet tight timeframes.
Refer members to various other departments (i.e., Case Management, Disease Management, TPL, COB) for follow-up as appropriate.
Properly request letters, including applying the appropriate legal and regulatory requirements for ICE and health plan specific letter Templates.
All other duties as assigned including department-specific functions and responsibilities:
Three (3) years of Medical/Surgical clinical nursing experience.
Proficient in Microsoft Office applications and other computer skills.

Are you looking for a challenging and rewarding role as a Concurrent Review Nurse I? Join our team and help us provide quality care to our patients while ensuring compliance with all regulatory requirements. We offer competitive compensation and a comprehensive benefits package. Apply now and be part of our team!

Overview Concurrent Review Nurse I is a healthcare professional who is responsible for providing medical review services to ensure that the care provided to patients is appropriate and cost-effective. They review medical records and other documentation to assess the appropriateness of care, and make recommendations for changes in care or treatment. Detailed Job Description Concurrent Review Nurse I is responsible for providing medical review services to ensure that the care provided to patients is appropriate and cost-effective. This includes reviewing medical records and other documentation to assess the appropriateness of care, and making recommendations for changes in care or treatment. The nurse will also provide education and support to healthcare providers and patients regarding the review process. Job Skills Required
• Knowledge of medical terminology and coding
• Ability to interpret medical records and other documentation
• Ability to assess the appropriateness of care
• Ability to make recommendations for changes in care or treatment
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Knowledge of healthcare regulations and standards
• Knowledge of computer systems and software
Job Qualifications
• Bachelor’s degree in Nursing or related field
• Current RN license in the state of practice
• At least two years of experience in a clinical setting
• Experience in concurrent review or utilization management
• Certification in case management or utilization review
Job Knowledge
• Knowledge of medical terminology and coding
• Knowledge of healthcare regulations and standards
• Knowledge of computer systems and software
Job Experience
• At least two years of experience in a clinical setting
• Experience in concurrent review or utilization management
Job Responsibilities
• Review medical records and other documentation to assess the appropriateness of care
• Make recommendations for changes in care or treatment
• Provide education and support to healthcare providers and patients regarding the review process
• Monitor patient care to ensure that it is appropriate and cost-effective
• Maintain accurate records and documentation of reviews
• Collaborate with other healthcare professionals to ensure quality care