- Aequor (New York, NY)
- …nursing professional Minimum experience of 1-3 years in case management, utilization review and/or quality assurance Experience in episodic care, wellness care and ... counseling of adults Proficiency in use of electronic medical record keeping systems desirable BLS certification required Optional:...days onsite, then 4 days/week onsite and 1 day remote ) 8:30 AM to 4:30 PM (Monday - Friday)… more
- Merck & Co. (New Orleans, LA)
- …drug distribution (Oncology group purchasing organizations, wholesalers, and specialty pharmacies). Review and evaluate patterns for products purchased and prescribed ... the in-scope customer team: Customer Team Leader, Key Account Manager, Nurse Educator, Field Reimbursement Associate, Medicare Account Executive, and more.… more
- Actalent (Atlanta, GA)
- …care (PAC) facilities. You will work telephonically and collaborate with internal Medical Directors, Market Engagement Directors, and Nurse Managers to develop ... continued stay at SNF, IRF, LTACH and Home Health care using approved medical care guidelines and working on additional duties such as participating in performance… more
- University of Miami (Miami, FL)
- …please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Nurse Navigator - Site Disease Group - Remote ... Group has an exciting opportunity for a Per Diem Nurse Navigator. The Nurse Navigator is the...and assures timely scheduling of initial appointments. Reviews outside medical records for appropriate scheduling. Assess barriers to care… more
- Banner Health (Loveland, CO)
- …We are proud to offer our team members many career and lifestyle choices including remote & hybrid work options. Apply today. Banner Plans & Networks (BPN) is a ... and extend our innovation to employment settings by including remote and hybrid opportunities. As a RN Case Manager,...Diem positions do not have guaranteed hours and no medical benefits package is offered. Completion of post-offer Occupational… more
- 315 health (Tallahassee, FL)
- …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
- Insight Global (New York, NY)
- Job Description Insight Global is looking for a Pre-Access Utilization Management Registered Nurse to sit remotely with one of their large health insurance clients. ... to day this individual will be assessing patient care requests for medical services (such as surgeries, procedures, hospital admissions, etc.) and collaborating with… more
- CVS Health (Hartford, CT)
- …The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...appeals submitted by patients or healthcare providers for MD review . + Collaborate with internal business partners and external… more
- CVS Health (Hartford, CT)
- …The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This ... role is considered a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include, but are not limited to: requesting… more
- Trinity Health (Livonia, MI)
- …and selection of colleagues for the FIND/LCS program. 4. Responsible for payroll review , PTO approval and coverage. 5. Participates in regional staff evaluations. 6. ... offered the option of the recommended follow-up. 7. Provides personalized nurse navigation interventions to patients who request additional information, assessment… more
- Centene Corporation (Cheyenne, WY)
- …with interdepartmental teams on projects within utilization management as part of the clinical review team + Partners and works with Medical Affairs and/or ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Rising Medical Solutions (Chicago, IL)
- …optimizing bill review procedures and systems; and leading a team of experienced medical bill review auditors, nurse auditors, med-legal nurse , ... in State and Federal laws, rules or fee schedules that impact medical bill review /re-pricing and ensure they are integrated into workflows (and Smart Advisor via… more
- Centene Corporation (Oklahoma City, OK)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... flexibility. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance… more
- Marshfield Clinic (Marshfield, WI)
- …together to support the most exciting missions in the world!** **Job Title:** Registered Nurse - Acute - Critical Care - Medical ICU **Cost Center:** 301351127 ... (AHA) at time of hire. **Marshfield Medical Center** ** Medical Intensive Care Unit [MICU]** **Registered Nurse -Acute-Critical Care** **DEPARTMENT/UNIT… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Registered Nurse - Acute Medical (with Med/Surg Residency option) **Cost Center:** 301351177 ... at time of hire. **Marshfield Medical Center** **6 North- Acute Medical ** **Registered Nurse -Hospital** **DEPARTMENT/UNIT DESCRIPTION** 6 North is a 28-bed,… more
- Molina Healthcare (Bronx, NY)
- …Medicaid and Medicare.** **We are looking for a LPN or LVN Care Review Clinician with Prior Authorization experience. Experience with Utilization Management (UM) is ... highly preferred. Additional experience with appeals, quality review , MLTC/LTC experience, and experience with data collection/reports.** **_Bilingual candidates… more
- Molina Healthcare (CA)
- **JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSE ** **For this position we are seeking a (RN) Registered Nurse with previous ... experience in Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge of Interqual /...to work some weekends and holidays. This is a remote position and you may work from home. Please… more
- Veterans Affairs, Veterans Health Administration (Syracuse, NY)
- Summary Syracuse VAMC is looking for full-time Registered Nurses in the Medical /Surgical (Med/Surg). This is an Open & Continuous Announcement & will remain open ... until 02/14/2025 to fill current & future RN vacancies for the Medical /Surgical. Applications will be accepted on an ongoing basis & qualified candidates will be… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- Summary Position Title: Registered Nurse - Medical Oncology (Unit 4D) (Night Tour Only) (OCA) Responsibilities Please note: This is an open continuous posting and ... weeks until these positions have been filled. The Registered Nurse - Medical Oncology (Unit 4D) provides...VHA Education Loan Repayment Services program office after complete review of the EDRP application. Former EDRP participants ineligible… more
- Veterans Affairs, Veterans Health Administration (Atlanta, GA)
- …by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities This is an OPEN CONTINUOUS ANNOUNCEMENT ... an as-needed basis until positions are filled. PRIMARY ROLES OF THE REGISTERED NURSE -Med/ Surg - Documents assessment and interventions by policy and practice… more
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