- Sharecare (Dover, DE)
- …affordable for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals ... and cost-effective manner while ensuring high quality care. The Clinical Registered Nurse coordinates with the Primary...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Evolent (Dover, DE)
- …and client policies and procedures while complying with timeliness guidelines. Our clinical nurse reviewer team values collaboration, continuous learning, ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management … more
- Fresenius Medical Center (Dover, DE)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Lincoln Financial (Dover, DE)
- …looking for** * Minimum of 5 years of disability claims experience * Current Registered Nurse license or Licensure in Clinical psychology or Social Work * 4 ... a Glance** We are excited to bring on a Clinical Operations Manager to our organization. As a ...be responsible for leading and managing a team of nurse disability consultants and behavioral health consultants. This includes… more
- Veterans Affairs, Veterans Health Administration (Perry Point, MD)
- …in an environment that supports personalized and proactive care. Responsibilities The Nurse (RN) Care Coordinator provides direct staff support to the Office of ... The RN Care Coordinator is responsible for providing the clinical leadership and expertise for the coordination of the...He/she functions as part of the interdisciplinary team to review Community Care consults, screen, triage and coordinate care… more
- Lincoln Financial (Dover, DE)
- …Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible ... claims. In this role you will act as a clinical resource for Group Protection benefit specialists and claim...for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state… more
- Public Consulting Group (Dover, DE)
- …learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager will be ... efficient, equitable, and client-centered * Handles case assignments, draft service plans, review case progress, and manages ongoing care needs * Travels within the… more
- Fresenius Medical Center (Dover, DE)
- …regulations at: https://content.intranet.fmcna.com/regulatory-affairs/wp-content/uploads/sites/46/2019/05/Pre-Licensed- Nurse -50-State- Review ... of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a...for other staff members. + Routinely meets with the Clinical Manager to discuss personnel and patient care status,… more
- Public Consulting Group (Dover, DE)
- …efficient, equitable, and client-centered + Handles case assignments, draft service plans, review case progress and determine case closure + Travels within the State ... patients make informed decisions by acting as their advocate regarding their clinical status and treatment options + Develops effective working relations and… more
- Surgery Care Affiliates (Dover, DE)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... join our team, they will. Responsibilities We are actively hiring for an Registered Nurse Pre-Assessment Testing. + Promote the mission, vision, and values of SCA .… more
- Highmark Health (Dover, DE)
- …over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and ... utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent conducts… more
- CVS Health (Dover, DE)
- …some of the following roles (not all inclusive): -Through the use of clinical tools and information/data review , conducts an evaluation of member's needs ... functions as well as smooth transition to Aetna programs and plans. -Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and… more
- CVS Health (Dover, DE)
- …some of the following roles (not all inclusive): + Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and ... as well as smooth transition to Aetna programs and plans. + Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and… more
- Evolent (Dover, DE)
- …The Specialty Appeal nurses work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators who set up the ... appeal, Physicians and other Clinicians who review the appeal, and managers for direction and leadership. The Appeals teamwork strategies and opportunities for… more
- Sedgwick (Dover, DE)
- …Candidates must live within the United States. **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on ... Fortune Best Workplaces in Financial Services & Insurance Remote Accommodations Clinical Specialist- Bilingual French, Hindi, Bengali or more **We are looking… more
- Zurich NA (Dover, DE)
- …of Utilization Review and Pharmacy nurses who are responsible for the review of clinical services for the determination of medical necessity and ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking...and pharmacy operation's culture of continuous improvement of the clinical expertise across the organization. + Motivate and lead… more
- Fresenius Medical Center (Milford, DE)
- …effective dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies procedures and training and in compliance ... last treatment. Report any complaints or observations to the nurse supervisor. + Evaluate vascular access for patency and...activities. + Enters all treatment data into the designated clinical application accurately and in a timely manner. +… more
- Fresenius Medical Center (Smyrna, DE)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine...activities. + Enters all treatment data into the designated clinical application in an accurate and timely manner. +… more
- Sedgwick (Dover, DE)
- … Consultant) Certification or training preferred. **Experience** Five (5) years related clinical nursing experience and two (2) years nurse consultant experience ... Services & Insurance RN Consultant Sr - Professional Liability **Prior Legal Nurse Consulting expereince highly preferred in order to be considered.** **PRIMARY… more