- OhioHealth (Mansfield, OH)
- …/or to provide shadowing experiences for students. **Minimum Qualifications:** Bachelor's Degree: Nursing (Required) RN - Registered Nurse - Ohio Board of ... **Job Description Summary:** Given that the organization self-insures for professional liability claims , it is essential that the Sr Consultant Risk Management… more
- The County of Los Angeles (Los Angeles, CA)
- …Requirements SELECTION REQUIREMENTS: Option I: Five (5) years of experience as a Registered Nurse including two (2) years of experience in an administrative*, ... HEALTH FACILITIES CONSULTANT , NURSING Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2307969) Apply HEALTH FACILITIES...university AND four (4) years of experience as a Registered Nurse including two (2) years of… more
- HCA Healthcare (Nashville, TN)
- …and experience in multiple markets/divisions is a plus + Legal Nurse Consultant Certified (LNCC) preferred + Registered Nurse - Currently licensed ... in the pursuit of payment on unpaid and underpaid claims . Additionally, the Nurse Subject Matter Advisor...of similar claim issues. **Major Responsibilities:** + Conducts comprehensive clinical record reviews and detailed claims analyses.… more
- UNUM (Chattanooga, TN)
- …Help us help others, and join Team Unum today! **General Summary:** The clinical consultant is responsible for reviewing, analyzing and interpreting medical ... information. Works collaboratively with claims professionals, on-site physicians and other resources in multiple...**Job Specifications** + Associate Degree in Nursing and active RN License is required but BS degree strongly preferred… more
- CVS Health (Raleigh, NC)
- …3+ years of clinical experience in a healthcare setting. + 2+ years as a Registered Nurse ( RN ) or License Practical Nurse / License Vocational ... and compliance with regulatory and accreditation requirements. + Apply clinical criteria and policies to member/provider claims ...Nurse . + Active, current, and unrestricted RN /LVP/LPN license in the state of residence. + Proficiency… more
- NHS Management, LLC (Fayetteville, AR)
- …the successes they experience along the way. We are in search of a qualified Regional Nurse Consultant : The Regional Nurse Consultant will be responsible ... policies and established customer service program. 4. Monitor corporate clinical benchmarks, QI's, QM's and other available consultant...Holidays and Paid Vacation Requirements + Must be a Registered Nurse in good standing + Previous… more
- US Tech Solutions (Chesapeake, VA)
- …healthcare costs and improve healthcare program/operational efficiency involving clinical issues Determines medical necessity/ appropriateness Facilitates optimal ... enable decision making at most appropriate level **Duties:** + Nurse Case Manager is responsible for face to face...policies and programs are comprised of network management and clinical coverage policies. + Through the use of … more
- Emory Healthcare/Emory University (Atlanta, GA)
- …+ **Experience -** Minimum of 3 years of healthcare experience + **Licensure -** If Registered Nurse with BSN, must be a graduate of an accredited nursing ... with Emory's Care Transformation Model and just culture framework + Serve as a consultant to departments, providers, and claims /legal teams on risk reduction and… more
- CareFirst (Baltimore, MD)
- …strategies to improve individual and team-based performance as needed. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate...Case Manager Upon Hire Preferred + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred Salary… more
- Baylor Scott & White Health (Round Rock, TX)
- … experience. Or, an Associate's Degree in a healthcare field and six years of clinical experience. Or, an RN with less than a Bachelor's Degree and six ... patient harm. If organizational risk is found, the Corporate claims manager will review the event further. The CRM...years of clinical experience. + TX RN license if… more
- Elevance Health (Dearborn, MI)
- …inconsistent with the CBA, the CBA provisions will prevail._** The ** Clinical Care Manager II** provides assessments, referrals, and counseling. Conducts telephone ... assessments, collecting sufficient clinical information to make appropriate referral and certification decision...+ Conduct business in a professional manner. + Troubleshoot claims issues. + Investigate and research to resolve customer… more
- Alight (IN)
- …(https://careers.alight.com/us/en) . **Medical Nurse Consultant :** The Nurse Consultant functions as a member of our Clinical Center of Excellence ... in clinical guidelines in this industry, the Nurse Consultant facilitates medically sound decisions and... claims within their scope of licensure and clinical expertise. **You have** + Registered … more
- Alight (IN)
- **Medical Nurse Consultant :** The Nurse Consultant functions as a member of our Clinical Center of Excellence and serves as a clinical consult ... in clinical guidelines in this industry, the Nurse Consultant facilitates medically sound decisions and... claims within their scope of licensure and clinical expertise. **You have** + Registered … more
- UPMC (Pittsburgh, PA)
- …of very sensitive and confidential information.Licensure, Certifications, and Clearances: + Pharmacist OR Registered Nurse ( RN ) + Act 34 *Current licensure ... is systematic management of potential as well as actual claims . Clinical data will by analyzed to...and managing individual projects. Do you have an active RN License or a Pharmacist license, along with five… more
- Baystate Health (Springfield, MA)
- …standards from TJC, CMS, and other relevant agencies. **Preferred Qualifications:** + Clinical licensure (eg, RN , MD, DO) highly preferred. + Certified ... expert knowledge in federal, state and TJC standards and clinical and operational expertise to achieve and maintain a...not limited to, functioning as an expert resource and consultant to the organization, as a liaison between the… more
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