- 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 Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely ... Friday 8:00am - 5:00pm. **Essential Job Duties** * Performs clinical / medical reviews of retrospective medical ...hospital setting, including at least 1 year of utilization review , medical claims review , claims… 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
- Cognizant (Madison, WI)
- …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
- 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
- Marshfield Clinic (Beaver Dam, WI)
- …the most exciting missions in the world!** **Job Title:** Registered Nurse - Home Health/Hospice **Cost Center:** 351011118 BDHos-Home Health **Scheduled Weekly ... eligible for a sign-on bonus **JOB SUMMARY** The Registered Nurse - Home Health/Hospice is responsible for the provision...the agency team. The RN needs to have solid clinical expertise (assessment, critical thinking and clinical … more
- Veterans Affairs, Veterans Health Administration (Beaver Dam, WI)
- …and record relevant] patient information. Completed work should need only a general review by a registered nurse for appropriateness and conformity with ... Summary The Licensed Practical Nurse (LPN) FLOAT is located at our Beaver...provider visits and maintains clinic flow. Completion of pertinent clinical reminders and preventative health screenings. Documents all data… 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
- Marshfield Clinic (Beaver Dam, WI)
- …to support the most exciting missions in the world!** **Job Title:** Nurse Practitioner - Nursing Home **Cost Center:** 351011295 Beaver Dam-NH-Hillside Manor ... Mon-Fri; 8:00 am - 5:00 pm (United States of America) **Job Description:** The Nurse Practitioner- Nursing Home Service functions as a member of our primary care… 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
- Molina Healthcare (Madison, WI)
- … medical officer. * Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review and manages the denial ... * Collaborates with contracting department in contract negotiations. * Fosters clinical practice guideline implementation and evidence-based medical practices. *… more
- Marshfield Clinic (Columbus, WI)
- …to support the most exciting missions in the world!** **Job Title:** Nurse Practitioner or Physician Assistant - Primary Care **Cost Center:** 351011099 Beaver ... am - 5:00 pm (United States of America) **Job Description:** **JOB SUMMARY** The Nurse Practitioner, or Physician Assistant, is a skilled member of the health team… 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
- St Croix Hospice (Fort Atkinson, WI)
- …during operating hours to assist clinicians as appropriate. + Reviews patient's medical diagnosis, prognosis, medications, procedures, and clinical course. + ... Manager of Clinical Services Job Details Level Management Job Location...appropriate hospice personnel to case as needed. Conferences with Medical Director or Hospice Physician regarding any questions about… 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