, such as MCG criteria to complete initial and continued stay reviews in determining appropriate admission and continued stay status... basis. Performs retrospective reviews. Reviews all commercial accounts daily or as per contract or payer expectation...
Torrance Memorial ⚡⚡ Wed, 15 Apr 2026 07:47:20 GMT
, procedures, and facilities. The RN conducts timely reviews of inpatient and outpatient medical records to determine the... utilization and controlling costs. Assessment: Reviews patient records to perform utilization review and verify patient status...
information and patient information. Reconsiderations, assists with appeals as needed, arrange peer to peer level reviews... and retrospective reviews. Qualifications: Education: Bachelor's in Behavioral Health, Social Work, Counseling, Nursing...
, substance abuse, skilled nursing and rehabilitation for medical necessity; and all post claim or post service reviews. Ensure... disease and Nurturing Together program. Complete documentation for all reviews in Eldorado/Episodes; maintain confidentiality...
Personify Health ⚡ $25 - 30 per hour ⚡ Wed, 15 Apr 2026 04:58:45 GMT
services, procedures, and facilities. The RN conducts timely reviews of inpatient and outpatient medical records to determine... while optimizing resource utilization and controlling costs. Assessment: Reviews patient records to perform utilization review...
as needed, arrange peer to peer level reviews, and report the outcomes to the VP of Care Management and Team. Provides education... resolution of appeals/denials and retrospective reviews. Qualifications: Education: High School Diploma or GED and graduate...
payor specific Notice of Admission and continued stay reviews. “Performs utilization review activities under established... approval/denial of admission and continue stay review. They process payor denials and retro reviews, promote optimal health...
with the ongoing operation, maintenance, and development of the system. Coaches and reviews the work of lower level... professionals. Reviews and conducts cost/benefit evaluation of cloud solutions compared to virtual private networks, dedicated...
TIAA ⚡ $88900 - 116000 per year ⚡ Wed, 15 Apr 2026 00:17:33 GMT
necessity for admissions including appropriate patient status and continued stay reviews, possibly from an offsite location... Provides inpatient and observation (if indicated) clinical reviews for commercial carriers to the Financial Clearance Center...
Ensemble Health Partners ⚡ $39.4 - 53 per hour ⚡ Tue, 14 Apr 2026 23:02:46 GMT
for utilization reviews, ensuring that all records are complete, accurate, and accessible for audits and reviews. Monitor the status..., and other healthcare professionals to gather insights and ensure comprehensive reviews. Assist in preparing records and documentation...
ICBD ⚡ $55000 - 70000 per year ⚡ Tue, 14 Apr 2026 22:54:17 GMT
(EHR) or other relevant systems. Assist in tracking and organizing all documentation for utilization reviews, ensuring... that all records are complete, accurate, and accessible for audits and reviews. Monitor the status of pending authorizations...
ICBD ⚡ $55000 - 70000 per year ⚡ Tue, 14 Apr 2026 22:32:39 GMT
MUST ALREADY HAVE EXPERIENCE DOING BILL AUDIT REVIEWS FOR DIFFERENT STATES. We are seeking an experienced CPC...-certified medical coder with multi-state experience to perform coding audits, utilization reviews, demand package reviews...
Utilization Review Case Manager - FT Days 87510 - Utilization Review
, such as MCG criteria to complete initial and continued stay reviews in determining appropriate admission and continued stay status... basis. Performs retrospective reviews. Reviews all commercial accounts daily or as per contract or payer expectation...
Torrance Memorial ⚡ ⚡ Wed, 15 Apr 2026 07:47:20 GMT