- Actalent (Tampa, FL)
- Actalent is hiring a Clinical Review Nurse role! Job Description The Clinical Reviewer is a telephonic position responsible for recommending discharge plans, ... care guidelines and collaboration with key facility personnel. + Use clinical expertise to review clinical information and criteria to determine if the… more
- Actalent (Columbus, OH)
- …policies and standards. Essential Skills + Utilization management + Prior authorization + Utilization review + Clinical review + Patient care + Licensed ... Job Description The Authorization Specialist will perform medical necessity and clinical reviews of authorization requests in accordance with regulatory guidelines… more
- Children's Mercy Kansas City (Kansas City, MO)
- …improve the lives of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based ... from admission through hospital stay to discharge. Adeptly uses evidence based clinical practice guidelines to determine the appropriate level of care and the… more
- Hackensack Meridian Health (Edison, NJ)
- …transform healthcare and serve as a leader of positive change. The **Sleep Clinical Review Technician** is responsible for clinical history, signs/symptoms, ... diagnosis code and test order review . Works directly with team members and ordering clinicians and their staff to educate and support appropriate documentation for coding, authorizations and appropriate testing. This position will offer a hybrid schedule.… more
- St. Luke's Health System (Boise, ID)
- **Overview** At St. Luke's, our dedicated team of Clinical Review Nurses strive to build a positive, supportive, and inclusive culture that delivers exceptional ... **Category** _Nursing - RN and Leadership_ **Work Unit** _Clinical Review Management System Office_ **Position Type** _Full-Time_ **Work Schedule** _VARIABLE_… more
- Baptist Memorial (Memphis, TN)
- …(3) years? clinical experience in inpatient cardiovascular care setting. Clinical chart review and abstraction experience. Preferred/Desired + Previous ... Overview Job Summary Reviews clinical cases and abstracts data for inclusion in nationally recognized quality benchmarking databases (Society of Thoracic Surgeons,… more
- Trinity Health (Livonia, MI)
- …**Shift:** **Description:** Trinity Health at Home is seeking an experienced RN remote Clinical Quality Review Specialist with ICD10 HCS-D certification which is ... of hire **Trinity Health at Home is seeking an experienced RN Clinical Quality Review Specialist for a remote position** **ICD10 HCS-D certification which is… more
- LifePoint Health (Henderson, NC)
- …awards programs . And much more *Position Summary* Conducts chart audits/reviews for clinical practice guidelines, death review , blood review , core measures ... of CMS, TJC when performing chart abstractions for these entities. Performs clinical concurrent review , conducts team meetings, and coordinates internal… more
- BlueCross BlueShield of North Carolina (NC)
- **Job Description** Direct, manage and lead highly complex functional business area within Clinical Coding Review (CCR) to define and enable strategic and ... organization at external meetings with vendors, providers and customers as the clinical coding review expert and decision maker when needed + Create new … more
- Medical Mutual of Ohio (OH)
- …provider community, explaining processes for accessing health plan to perform clinical review , identifying appropriate community resources, or otherwise ... Supplement, and individual plans. Working under limited supervision, evaluates clinical information using evidence-based guidelines, company policies and individual… more
- HCA Healthcare (Nashville, TN)
- …each individual is recognized. Submit your application for the opportunity below: Clinical Denials Coding Review SpecialistParallon **Benefits** Parallon, offers ... Eligibility for benefits may vary by location._** We are seeking a Clinical Denials Coding Review Specialist for our team to ensure that we continue to provide… more
- BAYADA Home Health Care (Orlando, FL)
- …company match, direct deposit, and employee assistance program **Responsibilities:** + Review clinical information for appropriateness, congruency, and accuracy ... immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work...for this role (Please note, while this is a clinical opening, BAYADA does have non- clinical openings… more
- BAYADA Home Health Care (Orlando, FL)
- …about BAYADA Benefits, click here (https://www.bayada.com/benefits/) . **Responsibilities:** + Review clinical information for appropriateness, congruency, and ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding ...and meeting business and development goals. This is a **non- clinical ** role (Note: Clinical opportunities are also… more
- Centene Corporation (Jefferson City, MO)
- …to improve the review and execution of therapy services based on clinical reviews of service request. + Assesses and performs utilization reviews of service ... 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
- Centene Corporation (New York, NY)
- …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, ... workplace flexibility. **Must have an active, unrestricted New York State clinical license.** **Day shift Eastern Standard hours.** **Position Purpose:** Analyzes… more
- UCLA Health (Santa Monica, CA)
- …for the identification, collection, and entry of quality data for the Clinical Registries, Patient Safety Indicators (PSIs), and Hospital Acquired Conditions (HACs) ... program.This will involve applying your clinical knowledge to analyze data and identify trends and...improvement. You will serve as a liaison between the clinical stakeholders, clinical registries, and outsourced registry… more
- Centene Corporation (Nashville, TN)
- …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, ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- Actalent (Sunrise, FL)
- …team. In this role, you'll collaborate with an interdisciplinary team to review and authorize behavioral health and substance use services, ensuring appropriate care ... in crisis, including triage, discharge planning, and aftercare referrals. + Review treatment plans and collaborate with Medical Directors on medical necessity.… more
- State of Georgia (Fulton County, GA)
- Clinical Evaluator- Sexual Offender Risk Review ... Clinical Evaluator- Sexual Offender Risk Review Board- Atlanta Georgia - Fulton - Atlanta ... Job Sign Up for Job Alerts Job Description Job Title: Clinical Evaluator- Sexual Offender Risk Review Board- Atlanta Pay Grade: K Job Summary: Title Clinical… more
- Hackensack Meridian Health (Iselin, NJ)
- … results with staff and develop action plans for improvement. Responsible for clinical review . Implement action plans and complete trending reports. Attends and ... the Conditions of Participation (COPs). + Oversee recruiting of clinical staff. Review staffing and develop appropriate staffing plan to accomplish organization… more
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