- Evolent (Jefferson City, MO)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Humana (Jefferson City, MO)
- …Manager, Fraud and Waste Investigator: Nurse Audit/ Review performs clinical audit/validation processes to ensure that medical record documentation and ... approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to… more
- Humana (Jefferson City, MO)
- …needs and by providing guidance along the healthcare continuum. You will perform clinical case review on members during an inpatient hospital admission. You ... us put health first** The NICU Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates...+ Bilingual is a plus - preferably Spanish + Clinical claim review experience **Additional Information** +… more
- Highmark Health (Jefferson City, MO)
- …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
- Cardinal Health (Jefferson City, MO)
- …to ensure a positive and satisfactory experience for all customers. The Supervisor, Clinical Operations monitors nurse to patient contact quality and provides ... manufacturers to rethink the reach and impact of their products. The Supervisor, Clinical Operations provides management and clinical oversight to a team of… more
- Fujifilm (Jefferson City, MO)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...HCUS team to gain customer acceptance of the FUJIFILM Medical Systems solution. + Participates in teaching and training… more
- Intermountain Health (Jefferson City, MO)
- …or registrations: Registered Medical Assistant (RMA) of AMT, National Certified Medical Assistant (NCMA), Certified Clinical Medical Assistant (CCMA) or ... that invests in your growth** -with many career paths to explore, like Medical Assistant Senior, Registered Nurse , Practice Manager, and more! + **Intermountain… more
- Humana (Jefferson City, MO)
- …our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration...of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills,… more
- Centene Corporation (Jefferson City, MO)
- …clinical coding compliance nurses and non- clinical team members through medical claim review . Ensure compliance with coding practices through a ... comprehensive review and analysis of medical claims, ...and implements best practices and operational efficiencies + Researches clinical and coding questions and issues + Triages and… more
- CVS Health (Jefferson City, MO)
- …and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions ... it all with heart, each and every day. **Position Summary** Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit… more