- Evolent (Frankfort, KY)
- …mission. Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer , Nurse , you will be a key member of the utilization management ... providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will routinely interact with...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Evolent (Helena, MT)
- …Join a mission with a company behind it. **What You'll Be Doing:** As a Clinical Reviewer , Nurse , you will be a key member of the utilization management team. We ... providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will routinely interact with...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- AdventHealth (Orlando, FL)
- …collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...(ROM), and quality. + Completes accurate and timely record review to ensure the integrity of documentation compliance. +… more
- AmeriHealth Caritas (Washington, DC)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines ... **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient… more
- Catholic Health (Buffalo, NY)
- …EDUCATION + Graduate of an accredited School of Nursing + Bachelor of Science in Nursing (BSN) preferred + Current New York State RN license + Valid drivers license ... Salary: 67,606.50-101,419.50 USD Facility: Administrative Regional Training Cntr Shift: Shift 1 Status: Full Time FTE: 1.000000 Bargaining Unit: ACE Associates Exempt from Overtime: Exempt: Yes Work Schedule: Days Hours: 8:00am-4:00pm Summary: Conducts audits… more
- Hartford HealthCare (Hartford, CT)
- …The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation, ... registry activities, including program teleconferences and meetings. Maintains Surgical Clinical Reviewer (SCR) certification on an annual basis, in accordance with… more
- St. Luke's University Health Network (Bethlehem, PA)
- …regardless of a patient's ability to pay for health care. The Admission's Clinical Reviewer is responsible for the comprehensive medical review and screening of ... and responds to all inquiries for admission to ARC + Completes thorough review of documentation and information and assesses a patient's appropriateness for ARC… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Cook Medical (West Lafayette, IN)
- …is currently accepting applications for a Scientific Communications Medical Reviewer to join our growing Scientific Communications/Clinical team. Medical Reviewers ... provide medical review of documents written by team members who do...MD or DO with medical device experience preferred; however, nurse practitioners and physician assistants may qualify, depending on… more
- Zelis (St. Petersburg, FL)
- …interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay ... AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for… more
- SSM Health (MO)
- …to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, observed rate/expected rate ... (O/E ratios), industry trends, variable and diagnosis review group (DRG) frequency. + Serves as a liaison...- Regional MSO Credentialing + Or + Registered Professional Nurse (RN) - Illinois Department of Financial and Professional… more
- US Tech Solutions (Columbia, SC)
- …using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. **Responsibilities:** + 80% May ... any of the following in support of medical claims review and utilization review practices: Performs medical...compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LBSW (Licensed… more
- Centene Corporation (Harrisburg, PA)
- …claim reviews to ensure compliance with coding guidelines through a comprehensive review and analysis of claims, medical records, claims history, state regulations, ... and health plan provider calls. + Develop and maintain review guidelines for Corporate medical coding reviews. + Performs...a managed care organization preferred LPN - Licensed Practical Nurse - State Licensure required or RN - Registered… more
- US Tech Solutions (Columbia, SC)
- …decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. + Performs medical claim ... in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC) **About US Tech Solutions:** US Tech Solutions is a global… more
- Dignity Health (Chandler, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of ... Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're working in… more
- Houston Methodist (Houston, TX)
- …This position has achieved an expert level at all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist Nurse job roles ... At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) responsible for promoting the… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …integration of VHA and industry best standards. Responsibilities Responsibilities of the RUR Nurse Manager (NM) include, but are not limited, to the following: RUR ... Nurse Manager is accountable to the Consolidated Patient Account...the Community, DME, and Ambulance. Conducts clinical legal relatedness review for Regional Counsel TORT Claims, No Fault, and… more
- HCA Healthcare (Houston, TX)
- …you, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. Our team will promptly review your application. Highly qualified ... our colleagues in their positions. Join our Team as a(an) Registered Nurse Clinical Reviewer and access programs to assist with every stage of your career.… more