- Molina Healthcare (NE)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring ... Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… more
- CVS Health (Columbus, OH)
- …lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and… more
- STG International (Rockville, MD)
- STGi is currently seeking a Registered Nurse -Case Review Specialist . The position is remote and open to candidates nationwide. JOB SUMMARY: Provides direct ... with FOH Business Operations team. Serves as a Registered Nurse Case Review Specialist for the case... Corps - 60J, 60L, 61F, 61H, 61N, 61R,62B Medical Specialist Corps - 65B, 65C, 65D Nurse… more
- Veterans Affairs, Veterans Health Administration (Shreveport, LA)
- … Remote Patient Monitoring (RMP) Home Telehealth (HT) Registered Nurse (RN) Case Manager executes position responsibilities that demonstrates leadership, ... patient care. The RMP/HT is responsible to the Telehealth Nurse Manager. Responsibilities Care will be provided in the...Provides initial and ongoing comprehensive assessment to include a review of systems which establishes a comprehensive plan of… more
- Trinity Health (Albany, NY)
- …Brings patient to exam room, takes appropriate vital signs and documents in electronic medical record. + Review and update medication list to ensure accurate and ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Registered Nurse - Endocrinology - Albany, NY** If you are...complete list in electronic medical record (EMR) available for provider review … 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
- Trinity Health (Albany, NY)
- …Brings patient to exam room, takes appropriate vital signs and documents in electronic medical record. Review and update medication list to ensure accurate and ... MS & Headache - Albany, NY - full time -hybrid/ remote after training** If you are looking for a...complete list in electronic medical record (EMR) available for provider review … more
- CVS Health (Lansing, MI)
- …heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated **Appeals Nurse Consultant** to join our remote team. In this role, you will ... judgment and regulatory knowledge. **Key Responsibilities** + Responsible for the review and resolution of clinical appeals. + Reviews documentation and interprets… more
- University of Miami (Miami, FL)
- …or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... initial point of contact for a patient entering the health system. The nurse navigator assures timely scheduling of the first appointment, coordination of care after… more
- 315 health (Warner Robins, GA)
- …confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and ... management of their health through continuous care programs like Remote Patient Monitoring and Chronic Care Management. Our team works fervently to anticipate the… more
- University of Virginia (Culpeper, VA)
- …history and inputs into medical record system prior to visit for physician review + Completes UPG scribe training to documents in the medical record services ... real-time during patient encounters. + Maintain appropriate inventory of medical supplies and/or vaccines for the practice. + Acts...access, and Urinary Cath + Perform clinical prep to review records and studies, along with schedules and ensure… more
- Datavant (Little Rock, AR)
- …+ 3+ years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... you will play a pivotal role in elevating the impact of our medical record documentation. You will conduct daily evaluations and engage in direct communication… more
- Highmark Health (Harrisburg, PA)
- …to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and ... RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or...Working knowledge of pertinent regulatory and compliance guidelines and medical policies + Ability to multi task and perform… more
- TEKsystems (Orlando, FL)
- …change) Quality Assurance (2 Openings) Responsibilities: + Perform quality assurance review of peer review reports, correspondences, addendums, or supplemental ... and specifications are followed and all questions addressed. + Verify each review is supported by current clinical citations and references from reputable … more
- Actalent (Austin, TX)
- Clinical Review Nurse - Concurrent Review Location: Remote - Compact Nursing License required; must be able to work CST hours Schedule: Tuesday-Friday, ... Medicaid About the Role We are seeking a Clinical Review Nurse to perform concurrent reviews for...determine member health status, appropriate level of care, and medical necessity + Review acuity, resource consumption,… more
- Actalent (Orlando, FL)
- Clinical Review Nurse - Concurrent Review Location: Remote - Candidates can be live anywhere in the US but must be able to work CST hours Schedules ... 6:30 PM CST Position Overview We are seeking Clinical Review Nurses to join our remote team....concurrent reviews to assess member health, care setting, and medical necessity + Review acuity, resource use,… more
- Centene Corporation (Jefferson City, MO)
- …services to identify quality of care issues and, if identified, refer to the Medical Director for review and verification + Applies clinical knowledge to ensure ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Centene Corporation (Jefferson City, MO)
- …with quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against guidelines and ... of care issues, and if identified, refer to the Medical Director or provider for review and...assigned + Complies with all policies and standards **Location: Remote (Must be able to work in Central Time… more
- Centene Corporation (Columbus, OH)
- …some experience in the following areas: acute care, utilization management (UM)/ medical necessity review , InterQual knowledge, and discharge planning.** ... 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national...perspective on workplace flexibility. NOTE: This is a fully remote role. Preference will be given to applicants (1)… more
- Centene Corporation (New York, NY)
- …license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for ... necessity using appropriate criteria, referring those requests that fail review to the medical director for second...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more