- 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
- Veterans Affairs, Veterans Health Administration (Portland, OR)
- …The Remote Patient Monitoring (RPM) Home Telehealth (HT) Nurse Case Manager executes position responsibilities that demonstrate leadership, experience, and ... care supportive to or restorative of life and well-being; and executing medical regimens. Follows procedures per established policies and guidelines. Influences care… more
- Molina Healthcare (Los Angeles, CA)
- **JOB DESCRIPTION** **Job Summary** The **Delegation Oversight Nurse ** is responsible for ensuring that Molina Healthcare's UM delegates are compliant with all ... as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
- CVS Health (Phoenix, AZ)
- …high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Key Responsibilities** + Apply ... times may vary based on business needs) **Location:** 100% Remote (US only) American Health Holding, Inc. (AHH), a...(AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible,… more
- Ochsner Health (New Orleans, LA)
- …expertise as well as knowledge of utilization and discharge planning criteria to review medical information of prior hospitalized patients that are being ... options affecting OHS revenue as it relates to all medical necessity audits. **Education** Required - Registered Nurse...care as an RN. Experience in Case Management, Utilization Review and/or Discharge Planning .either in the Acute Care… more
- Molina Healthcare (San Jose, CA)
- …contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM ... as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
- 315 health (Warner Robins, GA)
- …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
- Medical Mutual of Ohio (OH)
- …pre-employment substance abuse and nicotine testing._ **Title:** _Clinical Appeal & Claim Review Nurse II_ **Location:** _Ohio_ **Requisition ID:** _2500127_ ... stay and level of care. + Extrapolates and summarizes medical information for physician review or other...degree preferred. + 3 years experience as a Registered Nurse in acute care, critical care, emergency medical… more
- University of Miami (North Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... SoLe Mia has an exciting opportunity for a Registered Nurse . CORE JOB SUMMARY The Registered Nurse ...to changing work demands and environment. Operates the appropriate medical equipment. . Adheres to University and unit-level policies… more
- Northwell Health (Lake Success, NY)
- …on assigned patient care units to clarify clinical documentation in the patient's medical record through a concurrent review process throughout the patient's ... mortality, and complexity of care provided. Responsible for concurrent inpatient medical record reviews for Medicare, Medicaid and all commercial payers. Generates… more
- Actalent (Columbus, OH)
- …timely review and approval of services. Responsibilities + Perform medical necessity and clinical reviews of authorization requests in accordance with regulatory ... of care. + Escalate complex or questionable cases to Medical Directors for further review . + Support...Prior authorization + Utilization review + Clinical review + Patient care + Licensed registered nurse… more
- Mosaic (Liberal, KS)
- …tasks according to Mosaic policies and state licensing requirements. + Maintain and review medical records of individuals served to monitor pertinent concerns ... that puts people first. We're looking for a Registered Nurse to join our team! With so many moving...monitor all aspects of an individual's care, including all medical /psychiatric concerns. Who will love this job: + A… more
- Actalent (Sunrise, FL)
- …staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, ... Utilization Management Nurse !Job Description The Utilization Management Nurse ...standardized Review Criteria. + Coordinate with the Medical Director/Physicians for requests outside standard Review … more
- CVS Health (Hartford, CT)
- …weekend and holiday on-call work. **Position Summary** Responsible for the review and resolution of clinical appeals. Reviews documentation and interprets data ... Qualifications** + Appeals Experience + Managed Care Experience + Utilization review experience + Proficiency with computer skills including navigating multiple… more
- Actalent (Tampa, FL)
- Actalent is hiring a Clinical Review Nurse role! Job Description The Clinical Reviewer is a telephonic position responsible for recommending discharge plans, ... service/device meets medical necessity for the member. + Ensure case review and elevation to complete the determination is rendered within contractual and… more
- AmeriHealth Caritas (Philadelphia, PA)
- …and goals + Following the shift care workflow the case is presented to the Medical Director for medical necessity review . Upon approval of services, ... shift care services including skilled nursing and home health aide services, medical daycare, and pediatric residential facilities. Upon receipt of a request from… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance ... guidelines to determine the appropriate level of care and the medical necessity of continued hospitalization. Secures initial payer authorization and continued… more
- Centene Corporation (New York, NY)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... hours.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance… more
- AmeriHealth Caritas (Washington, DC)
- …with medical policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical ... Bachelor's Degree in Nursing (BSN) preferred. + A Registered Nurse (RN) license in the District of Columbia in...and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care… more
- AmeriHealth Caritas (Dover, DE)
- …with medical policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical ... and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care...required. + An active DE or compact state Registered Nurse (RN) license in good standing is required. ;… more
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