- 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
- Cognizant (Providence, RI)
- …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
- 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 (Warwick, 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
- 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
- Humana (Providence, RI)
- …community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical … 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
- 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
- Sedgwick (Providence, RI)
- … Consultant) Certification or training preferred. **Experience** Five (5) years related clinical nursing experience and two (2) years nurse consultant experience ... Fortune Best Workplaces in Financial Services & Insurance Professional Liability Nurse Consultant **PRIMARY PURPOSE** **:** To handle complex or high exposure… 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
- Fujifilm (Providence, RI)
- **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 (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
