- Evolent (Olympia, WA)
- …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 (Tacoma, WA)
- 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 (Tacoma, WA)
- …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 (Olympia, WA)
- …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
- The Cigna Group (Olympia, WA)
- …outcomes, client growth and retention, and network performance. **OVERVIEW:** + The Nurse Executive Sales Specialist, trusted Clinical Leader, Educator and ... including medical cost driver analysis and action, complex case review , referral and engagement, account renewal consultation and recommendations to positively… more
- The Cigna Group (Seattle, WA)
- …retention, and network performance. **OVERVIEW:** + TheNurse ExecutiveSalesSpecialist, trusted Clinical Leader, Educator and Advocate, is closely aligned with ... trendsand maintains a working knowledge of Cigna business segment strategies, clinical programs, services and operational processes necessary to educate and provide… more
- DESC (Seattle, WA)
- …is done under the supervision of the ORCA Nurse Supervisor, Senior Nurse Manager, Director of Nursing, and Medical Director. **MAJOR DUTIES AND ... Center by first responders or transferred from local emergency departments + Provide clinical assessments, RN case management, medical monitoring, wound care and… more
- Fresenius Medical Center (Fircrest, WA)
- …and your career._ **Connect with your goals and change lives** **with Fresenius Medical Care North America.** Here is your opportunity to make profound connections ... diverse experiences and challenging career opportunities. When you join the Fresenius Medical Care team, you'll be welcomed into a company that is built… more
- General Dynamics Information Technology (Lakewood, WA)
- …**Job Family:** Healthcare Services **Skills:** Care Planning,Company Policies, Medical Information,Regulatory Requirements,Treatment Plans **Experience:** 2 + years ... Seize your opportunity to make a personal impact as Nurse Case Manager supporting mission critical work on an...of professional health nursing principles, practices, and procedures in clinical settings to analyze the full scope of problems… more
- Ageless Mens Health (Bonney Lake, WA)
- …training, compliance, and financial performance. + Conduct new patient consultations, review medical histories, and perform physical assessments. + Order, ... (PA-C or NP) to lead our Bonney Lake, WA clinic. This role combines clinical leadership, direct patient care, and operational management - helping women feel their… more
- CVS Health (Olympia, WA)
- …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 (Tacoma, WA)
- … 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
- Virginia Mason Franciscan Health (Tacoma, WA)
- …**Sign on Bonus for qualifying new external Clinic RNs available!** **Franciscan Medical Group, as part of Virginia Mason Franciscan Health, is currently seeking ... a full time Supervisor, Clinic Nurse , RN for our Franciscan Heart and Vascular Clinic...clinic. This role provides both leadership and hands on clinical expertise, ensuring high-quality patient care and smooth daily… more
- BioLife Plasma Services (Lacey, WA)
- …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
- Seattle Children's (Seattle, WA)
- …Research Institute. Lead, implement, and provide personnel management, fiscal analysis, review and reporting, compliance with appropriate regulations, and grant pre- ... and post-award management. May provide clinical care, as appropriate, as part of a research study. Provide leadership and coordination of research projects and other… more
- Virginia Mason Franciscan Health (Puyallup, WA)
- **Job Summary and Responsibilities** **Franciscan Medical Group, as part of Virginia Mason Franciscan Health, is currently seeking a full time Supervisor, Clinic ... Nurse , RN for our Franciscan Urgent Care Clinic in...met. **Essential Duties:** + Coordinate with the Clinic Manager, Medical Director and other staff to set appropriate goals… more
- Elevance Health (Seattle, WA)
- **Telephonic Nurse Case Manager II** **Sign on Bonus: $2000.** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- University of Washington (Seattle, WA)
- …full-time and part-time new employees joining UW Medicine** **UW Medical Center-Montlake** has outstanding opportunities for **experienced acute care Registered ... Care, Perinatal, Perioperative, Emergency Department, or outpatient or procedural areas, please review the postings on the website and apply to those positions when… more
- CenterWell (Kent, WA)
- …policies and standards. + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by ... help us put health first** $10,000 Sign-on Bonus The ** Clinical Manager** coordinates and oversees all direct care patient...Utilization Review staff. Upon completion of the assessment, creates and… more
- Sea Mar Community Health Centers (Seattle, WA)
- …by the Home Health Administrator. + Clinical Evaluation: + Interpret clinical data + Review patient satisfaction function as first-level complaint resolution ... Sea Mar's network of services includes more than 90 medical , dental, and behavioral health clinics and a wide...mandatory COVID-19 and flu vaccine organization Home Health RN Clinical Manager - Posting #25578 Hourly rate: $44.30 Annual… more