- Aequor (New York, NY)
- …nursing professional Minimum experience of 1-3 years in case management, utilization review and/or quality assurance Experience in episodic care, wellness care and ... counseling of adults Proficiency in use of electronic medical record keeping systems desirable BLS certification required Optional:...days onsite, then 4 days/week onsite and 1 day remote ) 8:30 AM to 4:30 PM (Monday - Friday)… more
- Merck & Co. (Billings, MT)
- …may include:- Health care providers such as physicians, physician assistants, nurse practitioners, nurses, pharmacists as well as quality directors and office ... at product workshops and conferences, as well as consistent and ongoing review of Company promotional materials.Providing Company management with updates on customer… more
- HumanEdge Travel Nursing and Allied Health (Hartford, CT)
- HumanEdge Travel Nursing and Allied Health is seeking a travel nurse RN Utilization Review for a travel nursing job in Hartford, Connecticut.Job Description & ... hours per weekShift: 8 hoursEmployment Type: TravelImmediate need for Utilization Review RNs for a Connecticut Healthcare Network. After orientation, this will… more
- Merck & Co. (West Palm Beach, FL)
- …drug distribution (Oncology group purchasing organizations, wholesalers, and specialty pharmacies). Review and evaluate patterns for products purchased and prescribed ... in-scope customer team: Customer Team Leader, Key Account Manager, Nurse Educator, Field Reimbursement Associate, Medicare Account Executive, and… more
- Saint Francis Health System (Tulsa, OK)
- …- 7aVirtual Nurse works from an on-site office location (not a remote position)Will perform admit, discharge chart review and other patient care duties ... Saint Francis Health System is seeking a Registered Nurse (RN) Virtual Care for a nursing job...adverse physiological trends, assurance of appropriate prophylactic strategies, and medical chart review . Virtually evaluates patients, educates… more
- TalentBurst, Inc (Clifton, NJ)
- TalentBurst, Inc is seeking a travel Medical Lab Scientist for a travel job in Clifton, New Jersey.Job Description & RequirementsSpecialty: Medical Lab ... weeks40 hours per weekShift: 8 hoursEmployment Type: Travel Title:Technical Lab - Medical Laboratory Scientist Location: Clifton, NJ Duration: 03 Months Is Covid… more
- Spectraforce Technologies (Columbia, SC)
- …decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Responsibilities: 80% ... Columbia, SC , 29229 (1 week Onsite training then remote ) Duration: 4 months assignment with possible extension Shift:...May provide any of the following in support of medical claims review and utilization review… more
- University of Miami (Miami, FL)
- …please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Nurse Navigator - Site Disease Group - Remote ... Group has an exciting opportunity for a Per Diem Nurse Navigator. The Nurse Navigator is the...and assures timely scheduling of initial appointments. Reviews outside medical records for appropriate scheduling. Assess barriers to care… more
- Walgreens (Deerfield, IL)
- …Opportunity Employer, including disability/veterans". **Job ID:** 1405241BR **Title:** Registered Nurse (RN) Specialty - Remote **Company Indicator:** Walgreens ... and merchandise. + Provides support within the scope of practice for a nurse and escalating to pharmacist for patient specific medication questions, including side… more
- 315 health (Tallahassee, FL)
- …confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and ... management of their health through continuous care programs like Remote Patient Monitoring and Chronic Care Management. Our team works fervently to anticipate the… more
- Fallon Health (Worcester, MA)
- …for Healthcare Effectiveness Data and Information Set (HEDIS(R)) and MassHealth Appendix Q review . The clinical nurse analyst will provide clinical expertise and ... + Strong clinical, interpersonal, analytical and communication skills. + Knowledge in medical record review with proven results. **COVID-19 Vaccination:** With… more
- Insight Global (New York, NY)
- Job Description Insight Global is looking for a Pre-Access Utilization Management Registered Nurse to sit remotely with one of their large health insurance clients. ... to day this individual will be assessing patient care requests for medical services (such as surgeries, procedures, hospital admissions, etc.) and collaborating with… more
- CVS Health (Hartford, CT)
- …The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...appeals submitted by patients or healthcare providers for MD review . + Collaborate with internal business partners and external… more
- CVS Health (Hartford, CT)
- …The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This ... role is considered a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include, but are not limited to: requesting… more
- Actalent (New York, NY)
- …Title: Care Manager I Job Description Conducts pre-certification, continued stay review , care coordination, or discharge planning for appropriateness of treatment ... setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Ensures...identification and management Work Site This is a fully remote position. Work Environment This is a 100% … more
- R1 RCM (Detroit, MI)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Utilization Review Nurse ** , you will help our hospital clients by ... experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines...**Here's what you will experience working as a Utilization Review Nurse :** + Perform initial admission and… more
- Centene Corporation (Cheyenne, WY)
- …with interdepartmental teams on projects within utilization management as part of the clinical review team + Partners and works with Medical Affairs and/or ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Rising Medical Solutions (Chicago, IL)
- …optimizing bill review procedures and systems; and leading a team of experienced medical bill review auditors, nurse auditors, med-legal nurse , ... in State and Federal laws, rules or fee schedules that impact medical bill review /re-pricing and ensure they are integrated into workflows (and Smart Advisor via… more
- Centene Corporation (TN)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... required** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance… more
- Centene Corporation (FL)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies… more
