- 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)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring ... Michigan RN license is required. **Job Duties** + Facilitates clinical / medical reviews of retrospective medical ...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- …in patient care through systematic evaluation and analytical review of clinical information. Responsibilities Responsibilities of the RUR nurse include, but ... Summary The Revenue Utilization Review (RUR) nurse is under the...Patient Accounting Centers (CPAC) for revenue reimbursement. The RUR nurse applies advanced clinical knowledge, communication skills,… more
- Fresenius Medical Center (Fitchburg, WI)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Molina Healthcare (Madison, WI)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests ... Central time Remote position **Essential Job Duties** * Performs clinical / medical reviews of previously denied cases in...specific programs supported by the plan such as utilization review , medical claims review , long-term… 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
- Select Medical (Madison, WI)
- …as a resource for healthcare professionals through fostering relationships within medical facilities. With clinical expertise and problem-solving skills, you'll ... of thousands of patients every day. **Responsibilities** **What a Clinical Liaison Does** At Select Medical , we...of care. **Qualifications** **What we're looking for in a Clinical Liaison** **Required Skills:** + Registered Nurse … 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 ... the US Department of Veterans Affairs (VA) is creating Clinical Deployment Teams (CDTs) to stand ready to assist....patient information. Completed work should need only a general review by a registered nurse (RN) or… 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
- 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 ... error. Provides safe administration of medications in accordance with Medical Center's and Nursing Service policy and monitors side...patient information. Completed work should need only a general review by a registered nurse (RN) or… more
- Datavant (Madison, WI)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… 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
- 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
- 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
- Oracle (Madison, WI)
- …+ Excellent communication, stakeholder engagement, and leadership skills. **Preferred Qualifications:** + Clinical experience as a nurse or physician with a deep ... **Job Description** The Clinical Note AI Agent Product Management Leader will...Gather and analyze information to define product specifications and review design specifications. Envision and communicate product strategy and… more
- Highmark Health (Madison, WI)
- …over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and ... utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent conducts… 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
- CenterWell (Madison, WI)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience,...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… 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