Concurrent Review Jobs (NOW HIRING)

Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of ...

Review prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed for additional expertise and ...

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years , we have been New Jersey's health solutions leader driving innovations that improve ...

Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team. * Identifies appropriate benefits, eligibility, and ...

This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and ...

Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of ...

Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum ...

Obtain and upload hospital and SNF medical records for concurrent utilization review. * Support Utilization Management nurses and case managers by gathering documentation for inpatient concurrent ...

Are you an experienced Registered Nurse with Utilization Review or Concurrent Review experience looking for a new opportunity with a prestigious Managed Care Company? Do you want the chance to ...

The employee conducts admission and concurrent reviews including observation and inpatients, identifies patients who do not meet criteria and takes action to ensure patients are cared for in the most ...

Calls insurance companies to obtain precertification or concurrent with the level of care. * Attend ... review processes

Review prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed for additional expertise and ...

Authorizes requested services according to Concurrent Review team guidelines. Contacts the health networks and/or CalOptima Health Customer Service department regarding health network enrollments.

Perform inpatient concurrent reviews and assess admissions/continued stays using MCG (Milliman Care Guidelines) . * Provide oversight for patients with complex or chronic conditions , identifying ...

Review and resolve authorization denials, medical necessity denials, level-of-care downgrades (inpatient to observation), and concurrent review denials issued by commercial, managed care, Medicare ...

Review and resolve authorization denials, medical necessity denials, level-of-care downgrades (inpatient to observation), and concurrent review denials issued by commercial, managed care, Medicare ...

Re- authorization/concurrent review for continued therapy: Reviews clinic documentation submitted by the provider to ensure services continue to meet defined plan guidelines. * Care Management

Review prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed for additional expertise and ...

Authorizes requested services according to Concurrent Review team guidelines. * Contacts the health networks and/or CalOptima Health Customer Service department regarding health network enrollments.

Review and resolve authorization denials, medical necessity denials, level-of-care downgrades (inpatient to observation), and concurrent review denials issued by commercial, managed care, Medicare ...