- Novo Nordisk Inc. (Cranston, RI)
- …Externally, the CMCS I maintains relationships with physicians, physician assistants, nurse practitioners, medical assistants, pharmacists, nurses and other ... Demonstrates understanding of territory customer groups and affiliations such as IPAs, Medical Groups, Health Systems, and Local Clinics and uses this to identify… more
- Evolent (Providence, RI)
- …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
- Fresenius Medical Center (Fairhaven, MA)
- …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
- Humana (Providence, RI)
- …Manager, Fraud and Waste Investigator: Nurse Audit/ Review performs clinical audit/validation processes to ensure that medical record documentation and ... approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to… more
- Veterans Affairs, Veterans Health Administration (Providence, RI)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... consults, scheduling surgery, CPRS navigation and VA administrative needs Triage and review new patient consult requests and ensure appropriate scheduling ( review… more
- Fresenius Medical Center (Providence, RI)
- …regulations at: https://content.intranet.fmcna.com/regulatory-affairs/wp-content/uploads/sites/46/2019/05/Pre-Licensed- Nurse -50-State- Review ... of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a...transcribes, and enters physician lab orders accurately into the Medical Information System. + Ensures appropriate preparation of lab… more
- Humana (Providence, RI)
- …in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The Nurse reviews the medical documentation, researching claims, ... and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to...Medical Directors on submitted G&A cases. The G&A Nurse will participate in initiatives which result in improved… more
- University Medicine (Providence, RI)
- SUMMARY: Reporting to the Manager of Case Management, the nurse case manager is responsible for providing comprehensive screenings, assessment, care coordination ... the intent of encouraging self-management for patients with chronic conditions. The Nurse Case manager is integrated in the office-based healthcare team and thereby… more
- Fallon Health (Foxborough, MA)
- …Information (CORI) results and reliable transportation **Experience:** * 1+ years of clinical experience as a Registered Nurse managing chronically ill members ... the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge,… more
- Brown University (Providence, RI)
- …and conduct support activities related to these duties. The Research NP will review medical histories with research participants, perform a physical examination ... Job Description: Position Purpose: The Research Nurse Practitioner (NP) will provide medical ...research participation, and administer questionnaires. The Research NP will review health updates and adverse event reports from study… more
- CVS Health (Woonsocket, RI)
- …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
- BioLife Plasma Services (Attleboro, MA)
- …You will report to the Plasma Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife ... of laboratory test results, and donor notification of unsuitable test results. The Medical Support Specialist (Plasma Center Nurse ) works under the guidance of… more
- CenterWell (Providence, RI)
- …complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to ... regarding Home Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services + Participates in special… more
- Datavant (Providence, RI)
- …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
- Prime Healthcare (Woonsocket, RI)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/229944/case-manager-registered- nurse /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityLandmark … more
- Highmark Health (Providence, RI)
- …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
- University Medicine (East Providence, RI)
- …and chief complaint. + Obtains lab specimens, gives injections, and performs routine medical tests. + Implements clinical and technical aspects of nursing care ... as they pertain to office nursing, which includes routine medical exams and/or procedures and tests in conjunction with...with prescribed policies, procedures, and techniques. + Assisting with review of test results under guidance of a physician… more
- CenterWell (Providence, RI)
- …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
- Aveanna Healthcare (Fall River, MA)
- Clinical Supervisor - RN Hybrid ApplyRefer a FriendBack Job Details Requisition #: 208995 Location: Fall River, MA 02723 Category: Nursing Salary: $85,000.00 - ... per year Position Details Aveanna Healthcare is hiring a Nurse Supervisor in your area! Make a difference every...by being a part of the delivery of unmatched clinical care for Aveanna' s clients at home. Put… more
- Cardinal Health (Providence, RI)
- …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
