- Evolent (Jefferson City, MO)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Centene Corporation (Jefferson City, MO)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... **This position is responsible for completing daily reviews determining medical necessity, communicating with providers regarding authorization status and also… more
- Cognizant (Jefferson City, MO)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. . Medical Necessity Reviews can… more
- Centene Corporation (Jefferson City, MO)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- CVS Health (Jefferson City, MO)
- …benefit overall claim management. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to ... in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993,… more
- CVS Health (Jefferson City, MO)
- …criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review . + Conduct clinical reviews via phone and electronic ... Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care… more
- Cardinal Health (Jefferson City, MO)
- …to ensure a positive and satisfactory experience for all customers. The Supervisor, Clinical Operations monitors nurse to patient contact quality and provides ... manufacturers to rethink the reach and impact of their products. The Supervisor, Clinical Operations provides management and clinical oversight to a team of… more
- Fujifilm (Jefferson City, MO)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...HCUS team to gain customer acceptance of the FUJIFILM Medical Systems solution. + Participates in teaching and training… more
- Centene Corporation (Jefferson City, MO)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services...state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or… more
- Humana (Jefferson City, MO)
- …our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration...of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills,… more
- Centene Corporation (Jefferson City, MO)
- …clinical coding compliance nurses and non- clinical team members through medical claim review . Ensure compliance with coding practices through a ... comprehensive review and analysis of medical claims, ...and implements best practices and operational efficiencies + Researches clinical and coding questions and issues + Triages and… more