- Centene Corporation (Olympia, WA)
- …bring expertise in:** + Licensed as an RN **or** an LPN + Experience with clinical review processes + Familiarity with the InterQual criteria system + Background ... be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- Molina Healthcare (WA)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for medical ... and cost-effective member care. **ESSENTIAL JOB DUTIES:** + Facilitates clinical / medical reviews of retrospective medical ...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… 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
- Molina Healthcare (Tacoma, WA)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests ... Central time Remote position **Essential Job Duties** * Performs clinical / medical reviews of previously denied cases in...specific programs supported by the plan such as utilization review , medical claims review , long-term… 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
- Elevance Health (Seattle, WA)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Clinical Fraud Investigator II** is responsible… more
- Humana (Olympia, WA)
- …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
- 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
- Elevance Health (Seattle, WA)
- …states; therefore, Multi-State Licensure will be required.** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging ... ** Medical Management Nurse ** **Location Virtual: This...management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience;… more
- Fresenius Medical Center (Spokane, WA)
- …_Charge Nurse Guidance_ recommendations and oversee all dialysis related medical and emergency functions. + Communicates with the physician and other members ... **PURPOSE AND SCOPE:** The Inpatient Services Charge Nurse is an additional "responsibility" assigned to the...accordance with the TAP scheduling tool. + Maintain and review the daily TAP tool for all hospitals/facilities under… 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
- Gentiva (Pullman, WA)
- …(LCD) criteria per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and ... Partnerships. Transform Hospice Care.** We are seeking a dedicated Hospice Nurse Practitioner to perform Face-to-Face (F2F) encounters essential for hospice… more
- Humana (Olympia, WA)
- …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
- Battelle Memorial Institute (Tacoma, WA)
- …Research and Analytics (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support of our government customer, ... and their families, ensuring comprehensive support for those who serve. As a Nurse Case Manager, you will contribute to impactful research and analytics that drive… more
- Humana (Olympia, WA)
- …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
- Sunrise Senior Living (Bellevue, WA)
- …NAME** Sunrise of Bellevue **Job ID** 2025-228848 **JOB OVERVIEW** The Wellness Nurse is responsible for monitoring the health and well-being of our residents ... administration, communication with resident support services and families, and maintaining clinical quality assurance while leading and demonstrating the Mission for… more
- Veterans Affairs, Veterans Health Administration (Spokane, WA)
- …and record relevant patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... is assigned to the Community Living Center (CLC) at the Mann-Grandstaff VA Medical Center in Spokane, WA. The Community Living Center (CLC) provides 24-hour skilled… 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
- 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