- Constructive Partnerships Unlimited (Manhattan, NY)
- Nurse Reviewer Type of Position Per Diem Search Location(s) Manhattan, NY Apply Now ... (https://phe.tbe.taleo.net/phe03/ats/careers/v2/applyRequisition?org=CPOFNYS&cws=37&rid=6656) Job Brief The Nurse Reviewer plays a critical role in safeguarding… more
- HCA Healthcare (Houston, TX)
- …set us apart from any other healthcare provider. We are seeking a(an) Registered Nurse Clinical Reviewer to join our healthcare family. **Benefits** The Woman's ... their passion for patient care. Apply today for our Registered Nurse Clinical Reviewer opportunity. **Job Summary and Qualifications** We are seeking a… more
- Elevance Health (Grand Prairie, TX)
- ** Nurse Reviewer I** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... integration, and ensures essential face-to-face onboarding and skill development. The ** Nurse Reviewer I** will be responsible for conducting preauthorization,… 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
- Elevance Health (San Juan, PR)
- …providing information technology and business operations services for health plans._ ** Nurse Reviewer I** **Location:** This role requires associates to ... but must be flexible according to business needs. The ** Nurse Reviewer I** is responsible for conducting...meets medical necessity criteria or requires additional medical necessity review . + Conducts initial medical necessity review … more
- CVS Health (Austin, TX)
- …And we do it all with heart, each and every day. **Position Summary** The Clinical Nurse Reviewer will serve as the designated lead for STAR Kids rolling month ... the full oversight, coordination, and execution of the audit process. The nurse will work collaboratively with service coordination teams, quality assurance, and… more
- Veterans Affairs, Veterans Health Administration (Salem, VA)
- Summary The Referral Coordinator Initiative (RCI) Nurse Practitioner is aligned under the Access and Scheduling Management Service and directly reports to the RCI ... Manager. Using the VHA Referral Coordination Initiative Implementation Guidebook, the Nurse Practitioner is responsible for enhancing the quality of clinical… more
- US Tech Solutions (Canton, MA)
- …extension)** Notes: Fully remote, MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that ... a clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical necessity and, therefore,… more
- Commonwealth Care Alliance (Boston, MA)
- …of community-based assessments for CCA members and ongoing tracking and monitoring. The RN MDS Reviewer is a member of the Minimum Data Set (MDS) Clinical Review ... team of the Care Planning Unit. The RN MDS Reviewer supports successful completion and submission of the MDS...form based on diagnoses / information gathered from record review . + Prepares printed MDS forms for data entry.… more
- Lee County Board of County Commissioners (Fort Myers, FL)
- Plan Reviewer Print (https://www.governmentjobs.com/careers/leecounty/jobs/newprint/4918314) Apply Plan Reviewer Salary $31.25 - $45.67 Hourly Location Fort ... Department is seeking a qualified individual to fill the position of Plan Reviewer . The Plan Reviewer will be responsible for reviewing residential and/or… more
- AdventHealth (Maitland, FL)
- …collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...(ROM), and quality._ + _Completes accurate and timely record review to ensure the integrity of documentation compliance._ +… more
- Magellan Health Services (Baton Rouge, LA)
- …engagement, and system-level collaboration with other child-serving agencies. The Clinical Reviewer will support the implementation and ongoing oversight of quality ... + Provides training, interpretation and support for QI Clinical Reviewer staff. + Audits and validates internal audit results...Professional Clinical Counselor - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt… more
- HCA Healthcare (Kingwood, TX)
- …step in your career path, we encourage you to apply for our Registered Nurse RN Emergency Department opening. We review all applications. Qualified candidates ... you have the career opportunities as a(an) RN Clinical Reviewer you want in your current role? We invest...as assigned. What qualification you will need: + Registered Nurse , prefer at least one year of experience +… more
- SSM Health (MO)
- …specialized mortality reviews. **Required Qualifications:** + Prior experience as a Second Level Reviewer + Two years in an acute care setting with two years ... to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, observed rate/expected rate… 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
- Nuvance Health (Poughkeepsie, NY)
- *Description* Summary: *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, Risk Management, Infection ... program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as appropriate.… more
- Kelly Services (Plainsboro, NJ)
- **Pharmacovigilance QC Reviewer II** Location: Plainsboro, NJ Schedule: Hybrid role with at least 3 days/week onsite is expected Length 1 year Pay: 28:00 **Job ... Level: Minimum Bachelor's degree, HCP degree is required eg, pharmacist or nurse ; advanced degree preferred * Experience Level: 3+ Years of in Pharmacovigilance… more
- Catholic Health Initiatives (Lexington, KY)
- **Responsibilities** **JOB SUMMARY:** The Bariatric Clinical Reviewer plays a crucial role in ensuring departmental compliance with MBSAQIP Data Registry and other ... school of nursing required. BSN preferred. License/Certification: * Active, unencumbered Registered Nurse license * BLS required * ACLS required on telemetry units… more
- SSM Health (MO)
- …the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate diagnosis review group (DRG) assignment, risk of mortality (ROM), and severity of ... documentation in the health record. + Attends department meetings to review documentation related issues. Conducts independent research to promote knowledge of… more
- ManpowerGroup (Columbia, SC)
- **Utilization Management Nurse / Social Worker (Contract Position)** **Location:** Remote (Must Train Onsite for 1-2 Weeks) - Must Reside Within 3 Hours of Client ... Format:** Microsoft Teams **Job Overview** We are seeking a **Utilization Management Nurse or Licensed Social Worker** to perform medical reviews and utilization… more