- HCA Healthcare (Austin, TX)
- …to the Maternal Program Manager using facility approved audit tools. As the NICU Clinical Nurse Reviewer , . You will review patient's medical record and ... apart from any other healthcare provider. We are seeking a(an) Clinical Nurse Reviewer Neonatal ICU to join our healthcare family. **Benefits** St. David's North… more
- Elevance Health (Indianapolis, IN)
- ** Nurse Reviewer I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... rotating weekends.** **New Grads are encouraged to apply!** The ** Nurse Reviewer I** will be responsible for...that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day… more
- Chenega Corporation (Rockville, MD)
- …**Chenega Professional Services Strategic Business Unit** company, is looking for a Nurse Practitioner-Contract Medical Reviewer (CMR) to support the Department ... closely with the Government and Contractor team trainers, physicians, and nurse practitioners. + Support management, administration, data, communication, and other… more
- Evolent (Olympia, WA)
- …mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance ... with the Director of UM to ensure client satisfaction. Perform all peer clinical review activities while located in a state or territory of the United States. Acts… more
- AmeriHealth Caritas (Lafayette, LA)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines ... Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. **Licensure:** + An active Registered Nurse (RN)… more
- AmeriHealth Caritas (Washington, DC)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines ... on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the appropriateness of services, identifies care coordination opportunities,… more
- Hartford HealthCare (Hartford, CT)
- …The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation, ... registry activities, including program teleconferences and meetings. Maintains Surgical Clinical Reviewer (SCR) certification on an annual basis, in accordance with… more
- Adecco US, Inc. (Minneapolis, MN)
- …days **Pay:** $40.50 to $42.50 an hour **Responsibilities of the RN Appeals Reviewer :** . Responsible for conducting thorough reviews of member and provider appeals, ... when appropriate. . You will summarize medical information for review by the Medical Director as needed, ensuring a...and meeting production goals. **Qualifications for the RN Appeals Reviewer :** . Associates degree . Active and good standing… more
- St. Luke's University Health Network (Bethlehem, PA)
- …regardless of a patient's ability to pay for health care. The Admission's Clinical Reviewer is responsible for the comprehensive medical review and screening of ... and responds to all inquiries for admission to ARC + Completes thorough review of documentation and information and assesses a patient's appropriateness for ARC… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Chenega Corporation (Rockville, MD)
- …Services Strategic Business Unit** company, is looking for a Physician- Contract Medical Reviewer (CMR) to support the Department of Health and Human Services (HHS), ... closely with the Government and Contractor team trainers, physicians, and nurse practitioners. + Support management, administration, data, communication, and other… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... + Process appeals, ensuring compliance with all regulatory milestones + Review medical records to identify Hospital-Acquired Conditions (HAC), ensure proper… more
- Zelis (FL)
- …interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay ... AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for… more
- Nuvance Health (Poughkeepsie, NY)
- …Must be available during weekday hours. 8a-5p *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, ... program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as appropriate.… more
- PruittHealth (Norcross, GA)
- **RN certified in OASIS and ICD 10 Reviewer ** **- HOME HEALTH SERVICES** **Must have ICD-10 Certification** **Join the PruittHealth @Home family, where we deliver ... CERTIFICATION, AND EDUCATIONAL REQUIREMENTS** + Current, active, and unrestricted Registered Nurse (RN) licensure in the state of practice **Family Makes Us… more
- SSM Health (MO)
- …to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, observed rate/expected rate ... (O/E ratios), industry trends, variable and diagnosis review group (DRG) frequency. + Serves as a liaison...- Regional MSO Credentialing + Or + Registered Professional Nurse (RN) - Illinois Department of Financial and Professional… more
- Kelly Services (Fargo, ND)
- …team: Proudly Serving Those Who Served** Are you a licensed MD, DO, Nurse Practitioner* (NP), or Physician Assistant* (PA) seeking meaningful work that fits ... Role** + Perform one-time veteran disability evaluations (DBQs/C&P exams) + Review health histories, assess whether injuries/conditions are likely service-related +… more
- Zelis (NJ)
- …Zelis standards regarding privacy What you'll bring to Zelis: + Registered Nurse licensure preferred + Inpatient Coding Certification required (ie, CCS, CIC, RHIA, ... RHIT) + 5+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred + Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers + Experience and working knowledge of Health… more
- Dignity Health (Chandler, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of ... Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more