Synergy Medical Staffing is seeking a travel nurse RN Long Term Care (LTC) Utilization Review for a travel nursing job in Middletown, Rhode Island. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date...

Cross Country Nurses is seeking a travel nurse RN Utilization Review for a travel nursing job in Astoria, New York. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 11/23/2026 Duration: 8 weeks ...

Experience with UR admission criteria, appeals and denials, concurrent review, continued stay reviews, medical necessity...

Case Review Analyst Req number: R8858 Employment type: Full time Worksite flexibility: Onsite Who we are CAI is a global services firm with over 9,000 associates worldwide and a yearly revenue of $1.3 billion+. We have over 40 yea...

How you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays... and on a timely basis. Interface with managed care organizations, external reviews, and other payers. Communicate with physicians...

Responsibilities The Valley Health System has expanded into an integrated health network that serves more than two million people in Southern Nevada. Starting with in 1979, the Valley Health System has grown to include , , , Benefit Hig...

and execution timelines. · Direct targeted reviews and continuous monitoring activities across the US credit portfolios, ensuring...

between managed care organizations and the facility professional clinical staff. ​Conduct reviews, in accordance..., as required by the facility leadership or corporate office. ​Conduct quality reviews for medical necessity and services provided...

when applicable. Reviews daily reports to ensure all records are processed. Consults with field clinical staff regarding...

prevention. This position conducts provider-focused documentation and coding reviews, identifies trends and opportunities..., and sustained provider engagement. JOB DUTIES/RESPONSIBILITIES Duty 1: Conducts provider documentation and coding reviews...

quality standards are met. KEY RESPONSIBILITIES: Reviews the eligibility changes and makes recommendations to improve the... effectiveness of the individual representatives. Reviews Medicare Advantage TRR changes Responsible for supporting performance...

IN-IDOC SVOR Review Coordinator: Review legal and court records, maintain registry data, conduct registration reviews.... Update and maintain Department, state, federal, and registry tracking systems. Complete case reviews and prepare...

, continued-stay, and discharge reviews using clinical criteria (InterQual or MCG). Insurance & Payer Relations: Manage pre...-certifications, concurrent reviews, and peer-to-peer escalations with commercial insurers, Medicare, and Texas Medicaid managed care...

reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce... coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render...

for the needs of the structures, and comply with the Department’s policies, guidelines, and standards. Assigns and reviews... periodic reviews and/or evaluations; determining subordinates' training needs and providing or arranging for such training...

discipline reviews for code and standards compliance Communicating with facility representatives, tenants, reviewers...

for payment and revenue reporting, including coding /edit reviews. Ensures all professional aspects of the assignment.... Reviews provider patient charting to ensure accuracy as well as adherence to correct coding initiative guidelines. Adheres...

ancillary department personnel. In this role, the employee will perform comprehensive retrospective reviews in a timely manner...

a team responsible for clinical reviews using established guidelines, clinical criteria, and applicable state and federal...: Manage a team responsible for completing administrative short-stay inpatient hospital reviews in accordance with federal...

execution of enterprise AI governance reviews, ensuring AI use cases are assessed consistently, documented appropriately..., and track conditions, evidence, and remediation actions through closure. Support both new AI reviews and periodic reviews...