- Actalent (Miami, FL)
- Urgent Hiring for " Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and ... complete cases. Qualifications: + 3+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and discharge… more
- Actalent (Baton Rouge, LA)
- Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse plays a critical role in analyzing prior authorization requests to determine the ... cost-effectiveness of medical care. Responsibilities + Perform medical necessity and clinical reviews of authorization requests to determine the appropriateness of… more
- Molina Healthcare (WI)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are ... Validation is a plus. Work hours: Monday - Friday 8:00am- 5:00pm Remote position **Essential Job Duties** * Performs clinical /medical reviews of previously… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding ... adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical ...and mandates. + Organizes the appeal case for physician review by compiling clinical , contractual, medical policy… more
- Centene Corporation (Jefferson City, MO)
- …administered with quality, cost efficiency, and are within compliance. + Performs a clinical review and assessment of relevant complex post-care services by ... fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review and assessment of complex...assigned + Complies with all policies and standards **Location: Remote (Must be able to work in Central Time… more
- Centene Corporation (Denver, CO)
- …management to identify and implement opportunities for improvement. + Oversees the clinical review of outcomes including creating and editing correspondence ... a fresh perspective on workplace flexibility. **Location: Position is remote . Prefer candidate to live in PST time zone.**...standards + Provides expert insight and guidance on the clinical review process of correspondence to ensure… 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, ... and cost effectiveness of medical care. + Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in… more
- Centene Corporation (Indianapolis, IN)
- …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, ... benefits including a fresh perspective on workplace flexibility. NOTE: This is a fully remote role with a focus on NICU services. **Preference will be given to… more
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt of high ... authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies...review and interpret medical records, treatment plans, and clinical documentation, with a keen eye for detail and… more
- Centene Corporation (Austin, TX)
- …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
- State of Colorado (Pueblo, CO)
- NURSE III - Clinical Specialist - Pueblo Regional Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5186234) Apply NURSE III - ... minimum staffing standards. This includes covering as a team nurse as needed. This position exists as a unit...and Health Care Technicians/QMAP. + Through direct observations and review of documentation determines if nurses are practicing critical… more
- Evolent (Lansing, MI)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as...Oncology, ICU, ED, or other critical care environment + Remote work experience To ensure a secure hiring process… more
- University of Washington (Seattle, WA)
- … Appeals and Disputes Nurse .** **WORK SCHEDULE** + 100% FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ... and communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process...**REQUIREMENTS** + Active licensure to practice as a Registered Nurse in Washington State + Bachelor's degree in Nursing… more
- Vitalief (Newark, NJ)
- …timelines, and ultimately improve patient outcomes. THE ROLE We are seeking an experienced Clinical Research Nurse to join our team as a full-time Vitalief ... clinical management of study participants. + Serve as a critical-thinking clinical partner-not a task-based nurse -demonstrating the ability to prioritize,… more
- Banner Health (Gilbert, AZ)
- …make Banner Health the best place to work and receive care. As a **RN Clinical Research Specialist in Outpatient Infusion** , you will play a vital role in ... patient care and administering investigational therapies in both early phase clinical trials, following established research protocols. This position requires a… more
- Vitalief (Philadelphia, PA)
- …operate more efficiently and grow sustainably. The Role We are seeking an experienced Clinical Research Nurse to join our exceptional team as a full-time ... and accelerate breakthroughs that improve patient care. Our team combines deep clinical research expertise with results-driven consulting to help organizations… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and… more
- Marshfield Clinic (Marshfield, WI)
- …together to support the most exciting missions in the world!** **Job Title:** Registered Nurse , Nurse Line ( Remote ) **Cost Center:** 301081199 Mfld- Nurse ... Regular **Work Shift:** Variable (United States of America) **Job Description:** The Registered Nurse , Nurse Line is responsible for triaging incoming calls for… more
- HCA Healthcare (San Juan, TX)
- …your career path, we encourage you to apply for our Clinical Nurse Coordinator Freestanding ED opening. We review all applications. Qualified candidates will ... **Introduction** Do you have the career opportunities as a Clinical Nurse Coordinator Freestanding ED you want...services into the Rio Grande Valley with our three remote ERs in McAllen/Mission, Edinburg, and San Juan. Our… more
- Geisinger (Danville, PA)
- …is a work on site position located in Danville, Pennsylvania. The Clinical Documentation Improvement Program (CDI) is designed to improve the physician's ... of care of the patient. The role of the Clinical Documentation Improvement Specialist (CDIS) is to assist the...highly trained staff members to perform a concurrent inpatient review of the record. This allows the record to… more