- Centene Corporation (Little Rock, AR)
- …with the correspondence team + Investigates denials through comprehensive review of clinical documentation, clinical criteria/guidelines, and policy, ... senior management to identify and implement opportunities for improvement. + Performs clinical review of outcomes including creating and editing denial letters… more
- Centene Corporation (Phoenix, AZ)
- …resolution and logs of actions and/or decisions are appropriately documented + Performs clinical review of outcomes including creating and editing denial letters ... with Federal, State, and NCQA standards + Investigates denials through comprehensive review of clinical documentation, clinical criteria/guidelines, and… more
- University of Miami (Miami, FL)
- …University of Miami/UHealth Department of SCCC has an exciting opportunity for a Full Time Clinical Research Nurse 2 to work at the UHealth Medical campus in ... Miami, Fl CORE JOB SUMMARYThe Clinical Research Nurse 2 ensures the integrity...the Investigator, Investigational Pharmacist, Comprehensive Treatment Unit (CTU)staff and Clinical Research Services Senior Manager to review … more
- Cleveland Clinic (Cleveland, OH)
- …and the Governing Body of the applicable hospitals. **CNS** + Currently licensed as a Clinical Nurse Specialist in applicable state(s). + Must be licensed as an ... RN in applicable state(s). + National certification as a Clinical Nurse Specialist by nationally accredited organization recognized by state Board of Nursing. +… more
- Guidehouse (Huntsville, AL)
- **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The **R** **emote** ** ... Clinical Denials RN** is responsible for review ,...from Guidehouse email domains including @guidehouse.com or ###@myworkday.com . Correspondence received by an applicant from any other domain… 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 ... Translational Research Site is currently seeking a full time Clinical Research Nurse to work in Miami....+ Performs study data collection and entry using charts, correspondence , medical records, and relevant communications. + Identifies and… more
- Cleveland Clinic (Cleveland, OH)
- …first IBD APP Fellowship in the country. This Fellowship will foster growth in both clinical and research arenas and build an extensive knowledge base on care of IBD ... The APP Fellow will spend approximately seventy percent of their time on direct clinical care of patients. The first quarter of the fellowship will be spent on… more
- University of Miami (North Miami, FL)
- …University of Miami/UHealth Department of SCCC has an exciting opportunity for a Full Time Clinical Research Nurse 1 to work at the UHealth medical campus in ... Miami, Fl. CORE JOB SUMMARYThe Clinical Research Nurse 1 ensures the integrity and quality of clinical research studies are maintained and conducted in… more
- University of Miami (Miami, FL)
- …University of Miami/UHealth Department of SCCC has an exciting opportunity for a Full Time Clinical Research Nurse 1 to work at the UHealth Medical campus in ... Miami, Fl CORE SUMMARY The Clinical Research Nurse 1 ensures the integrity...4. Performs study data collection and entry using charts, correspondence , medical records, and relevant communications. Identifies and procures… more
- Fresenius Medical Center (Waldorf, MD)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... **About this role:** As a Clinical Manager with Fresenius Medical Care, you will...+ Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence … more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... in nearly every medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services (EMS) Agency and the… more
- Commonwealth Care Alliance (Boston, MA)
- …and summarizes medical information for medical director, consultants, and other external review . + Prepares recommendations to either uphold or deny appeal and ... best practice standards, as well as a broad knowledge base and sound clinical judgment in reviewing medical records and writing appeals. + Participate in telephonic… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …in a UM team within managed care setting. * 5+ years experience in clinical nurse setting preferred. * TPA Experience preferred. About At Brighton Health ... Appeals & Grievances, and Quality Departments as needed. * Develop and review member centered documentation and correspondence reflecting determinations in… more
- Community Health Systems (Naples, FL)
- …UR improvement programs + Addresses facility and departmental communication through daily review of all correspondence , including incoming email messages. + ... Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders...or + Bachelor's Degree BSN required + 2-4 years clinical practice experience required + Experience in HEDIS, MIPS,… more
- State of Colorado (Pueblo, CO)
- Nurse Supervisor - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4996785) Apply Nurse Supervisor - Pueblo Salary $8,369.00 - ... $11,717.00 Monthly Location Pueblo, CO Job Type Full Time Job Number Nurse III SCCF 10189 07/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (Sterling, CO)
- CDOC Registered Nurse - Part-time - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4992041) Apply CDOC Registered Nurse - ... Sterling, CO Job Type Part Time Job Number CAA Nurse I SCF 07/2025 Department Department of Corrections Division... I SCF 07/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 07/01/2025 Closing Date… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4963973) Apply CDOC Registered Nurse ( Nurse I) ... $7,442.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 06/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (Sterling, CO)
- Licensed Practical Nurse - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4985150) Apply Licensed Practical Nurse - Sterling ... treatment plans, employs infection control measures, provides referral to appropriate Clinical Services staff for new arrivals, crisis intervention, interviews and… more
- Veterans Affairs, Veterans Health Administration (Green Bay, WI)
- Summary Full time opening for a Nurse Practitioner in Dermatology at the Northeast WI Ambulatory Clinics primarily servicing the Milo C. Huempfner Green Bay HCC. The ... and advancement of the VA mission. The NP will provide advanced clinical practice, consultation, and management. Preferred Experience: 5 years as Dermatology NP… more
- State of Michigan (MI)
- …may include: Duane Waters Health Care Facility -This is a senior Registered Nurse position that requires advanced clinical decision-making skills and judgment. ... Ambulatory Care, Prison Facility -This is a senior Registered Nurse position which requires advanced clinical decision...required to report any possible conflict of interest, please review the information and be prepared to respond to… more