- Lucile Packard Children's Hospital (Palo Alto, CA)
- …Palo Alto, CA Req: P138737-1155 Employee Group: CRONA Benefits Eligible: Yes Remote Eligible: No Department: Labor and Delivery LPCH Scheduled Weekly Hours: 36 ... nature, level and purpose of the job. The Clinical Nurse II is an RN that practices as a...efficient, effective, and equitable. - Participates in the design, review , and evaluation of QI data and initiatives at… more
- Commonwealth Care Alliance (Boston, MA)
- …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has ... reports. **Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical… more
- Morley (Atlanta, GA)
- …opportunity to use your expertise in a new way! **_What to Expect_** As a remote Retail Auto Parts Specialist at Morley, you'll process retail parts and labor rate ... role)_ + See _Skills for Success_ below Tasks: + Review dealer submission of all job cards (repair orders)...or landline + Secluded and distraction-free work environment **_The Remote Experience_** Wondering what it's like to work for… more
- Morley (Lansing, MI)
- …working from home? This could be a fantastic opportunity for you! As a remote Warranty Support Specialist at Morley, you'll use your customer service expertise to ... trends + Offer timely and accurate solutions for claim review + Communicate with internal and external partners through...or landline + Secluded and distraction-free work environment **_The Remote Experience_** Wondering what it's like to work for… more
- Stanford Health Care (Palo Alto, CA)
- …compose professional and comprehensive appeal letters to payors after a detailed review of medical records. Ensure compliance with Medicare, Medicaid, ... Denial Analysis: Conduct thorough analyses of denials, evaluating the appropriateness of medical services and procedures. Ensure accurate coding with ICD, HCPCS, CPT… more
- SR International, Inc. (Phoenix, AZ)
- …for additional languages as needed. *Collaboration: Collaborate closely with the Clinical Nurse Abstractor and the Child Fatality Review Program Manager to ... languages is a plus. SOAZ - Posting ID # 5875 -AZDHS - Fatality Review Informant Interviewer Description The Informant Interviewer will serve as a key contributor to… more
- Teleflex (Houston, TX)
- Medical Sales Representative-Vascular-Houston **Date:** Oct 27, 2025 **Location:** Houston, TX, US **Company:** Teleflex **Expected Travel** : Up to 50% ... **Requisition ID** :12961 **About Teleflex Incorporated** As a global provider of medical technologies, Teleflex is driven by our purpose to improve the health and… more
- PharmaCord (Jeffersonville, IN)
- …by communicating clearly, focusing on the accuracy of the details of their medical records and your mastery of the program requirements, and ensuring their ... months (or sooner once proficiency in role is demonstrated). Review our Benefits & Perks below to learn more!...to follow up on proper submission and/or outcome Coordinates nurse teach with field-based nurse educators, as… more
- HealthCare Support (San Antonio, TX)
- …years of experience with data analysis/quality chart reviews. Must be able to review medical records and assess completeness. Preferred Qualifications for HEDIS ... The Clinical Quality LPN is responsible for onsite chart review and tracking, remote data mining in...and the Supervisor of Quality Operations to ensure that medical record data is successfully retrieved and accurately abstracted.… more
- Teleflex (Hartford, CT)
- Vascular Medical Sales Representative- Hartford CT **Date:** Oct 3, 2025 **Location:** Hartford, CT, US **Company:** Teleflex **Expected Travel** : Up to 50% ... a dynamic, growing team that offers healthcare providers an array of medical technology solutions that make a difference in patients' lives. **Position Summary**… more
- Morley (Saginaw, MI)
- …family or school obligations **_What You'll Do_** + **Assist with contract review and management, legal research, policy development and compliance** + Provide ... comprehensive support to our legal and compliance teams + Draft, review and revise legal documents and internal policies + Manage the contract review process,… more
- Somatus (Phoenix, AZ)
- …be the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Accrual of 3 weeks' Vacation (PTO) + Professional ... management and staffing needs. This role is a fully remote position with expected travel within your market with...control, and ongoing market labor and expense analysis + Review , manage and coordinate case assignments with care teams… more
- Morley (CA)
- **About the Role** **Location*: Southern California / Los Angeles area** **_( remote , periodic area travel required)_** Are you confident speaking in public, a ... the time + Work in partnership with the California review team (located in Michigan), evaluating vehicle buyback requests...and upbeat attitude Work Location** + This is a remote position that requires periodic travel to locations within… more
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt of high ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well as… more
- Actalent (Houston, TX)
- Immediate Hiring for " Remote Clinical Review RN" Job Description: + Perform concurrent reviews to assess member's overall health. + Review the type of care ... being delivered and evaluate medical necessity. + Contribute to discharge planning according to...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
- Zurich NA (Schaumburg, IL)
- Medical Bill Review Senior Nurse 127127 Zurich Insurance is currently looking for a ** Medical Bill Review Senior Nurse ** to work from our ... quickly and completely, provide status updates to ensure customer satisfaction. + Review assigned medical bills, apply technical insights, applying discretion… more
- Molina Healthcare (Buffalo, NY)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...responsible for review of documentation to ensure medical necessity… more
- CareFirst (Baltimore, MD)
- …mental health, psychiatric setting. **Preferred Qualifications:** + 2 years experience in Medical Review , Utilization Management or Case Management at CareFirst ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of...and mandates. + Organizes the appeal case for physician review by compiling clinical, contractual, medical policy… more
- CVS Health (Phoenix, AZ)
- …a team that's making a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in ... in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position… more
- CVS Health (Denver, CO)
- …do it all with heart, each and every day. **Position Summary** **This is a remote work from home role anywhere in the US with virtual training.** American Health ... Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...**Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
