- Evolent (Madison, WI)
- …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
- Molina Healthcare (Madison, WI)
- …for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, responsible for ... Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review...clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is a Registered Nurse (RN) who assists to control costs for VISN 10 and/or VISN 12 ... appropriate evidence-based practices for positive outcomes. Responsibilities The Revenue Utilization Review (RUR) Assistant Nurse Manager (ANM) is directly… more
- Fresenius Medical Center (Madison, WI)
- …patients with various shifts and work hours **PURPOSE AND SCOPE:** The registered professional nurse (CAP RN 1) position is an entry level designation into the ... Clinical Advancement Program for Registered Nurses. The CAP RN...months from date of hire. + Performs ongoing, systematic review and analysis of dialysis data for Home Therapy… more
- Veterans Affairs, Veterans Health Administration (Madison, WI)
- …Dual Care Veterans. Prioritizes effectively and manages time productively in the clinical setting. Knowledgeably follows and utilizes the nurse protocols ... and record relevant] patient information. Completed work should need only a general review by a registered nurse for appropriateness and conformity with… more
- CVS Health (Madison, WI)
- …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
- St Croix Hospice (Middleton, WI)
- …where you matter. Manager of Clinical Services Position Overview The Manager of Clinical Services (MCS) is an experienced nurse and the administrator of the ... care in their community. The manager is a Registered Nurse , managing the clinical team to ensure...to building and expanding the business. + Reviews patient's medical diagnosis, prognosis, medications, procedures, and clinical … more
- Cardinal Health (Madison, WI)
- …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 (Madison, WI)
- **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
- Molina Healthcare (Madison, WI)
- …records and other data in support of annual HEDIS project management and ongoing review of medical records submitted by providers. + Implements Molina Healthcare ... completion of any of the following programs: + Registered Nurse (RN) or State Licensed Vocational Nurse ... records collection and abstraction * 2+ years of medical record review experience **REQU** **I** **RED… more
- Molina Healthcare (Madison, WI)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents cases in a consistent… more
- Molina Healthcare (Madison, WI)
- …, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members… more
- Molina Healthcare (Madison, WI)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more
- Molina Healthcare (Madison, WI)
- JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more
- Molina Healthcare (Madison, WI)
- …compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Fresenius Medical Center (Fitchburg, WI)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies, procedures, and training and in compliance ... last treatment. Report any complaints or observations to the nurse supervisor. + Evaluate vascular access for patency and...activities. + Enters all treatment data into the designated clinical application accurately and in a timely manner. +… more
- Fresenius Medical Center (Fitchburg, WI)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies, procedures, and training and in compliance ... RELATED:** + Participates in the recruitment process for new clinical staff. + Assists with clinical orientation...information and/or change in patient condition directly to the nurse supervisor. + Observe patient, and conduct machine safety… more
- Molina Healthcare (Madison, WI)
- …of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality...Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review ,… more
- Molina Healthcare (Madison, WI)
- …of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality...Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review ,… more
- Molina Healthcare (Madison, WI)
- … medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial ... practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. *… more