- Idaho Division of Human Resources (Twin Falls, ID)
- Nurse Reviewer - MED Posting Begin Date: 2025/06/09 Posting End Date: 2025/07/07 Category: Nursing Work Type: Full Time Remote: Flexible Hybrid Location: ... Registered Nurse ? The Idaho Department of Health and Welfare is recruiting for a Nurse Reviewer (Registered Nurse , Senior RN) position in our Bureau of… more
- HCA Healthcare (Houston, TX)
- …set us apart from any other healthcare provider. We are seeking a(an) Registered Nurse Clinical Reviewer to join our healthcare family. **Benefits** The Woman's ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...passion for patient care. Apply today for our Registered Nurse Clinical Reviewer opportunity. **Job Summary and… more
- Elevance Health (Mason, OH)
- ** Nurse Reviewer I** **Location:** **Virtual:** This role enables associates to work virtually full-time, with the exception of required inperson training ... and ensures essential face-to-face onboarding and skill development. The ** Nurse Reviewer I** will be responsible for...reviews that are routine having limited or no previous medical review experience requiring guidance by more… more
- Commonwealth Care Alliance (Boston, MA)
- …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible… more
- Elevance Health (San Juan, PR)
- …providing information technology and business operations services for health plans._ ** Nurse Reviewer I** **Location:** This role requires associates to ... but must be flexible according to business needs. The ** Nurse Reviewer I** is responsible for conducting...meets medical necessity criteria or requires additional medical necessity review . + Conducts initial … more
- HCA Healthcare (Conroe, TX)
- …next step in your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. We review all applications. Qualified candidates ... Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- Lee County Board of County Commissioners (Fort Myers, FL)
- Plan Reviewer Print (https://www.governmentjobs.com/careers/leecounty/jobs/newprint/4918314) Apply Plan Reviewer Salary $31.25 - $45.67 Hourly Location Fort ... Department is seeking a qualified individual to fill the position of Plan Reviewer . The Plan Reviewer will be responsible for reviewing residential and/or… more
- AdventHealth (Altamonte Springs, FL)
- …collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...you will bring to the team:** . Reviews concurrent medical record for documentation compliance including completeness and accuracy… more
- HCA Healthcare (Pasadena, TX)
- …and Qualifications** The RN Clinical Reviewer conducts a comprehensive current review of clinical documentation within the medical record to achieve, ... or if additional documentation is necessary. + Performs the medical record review for conflicting, imprecise, incomplete,...growth, we encourage you to apply for our Registered Nurse Case Manager opening. We promptly review … more
- Independent Health (Buffalo, NY)
- …The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as ... document research of initial coverage determinations, and lead coordination of clinical review with appropriate internal stakeholders and Medical Director. This… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical … more
- Catholic Health Initiatives (Lexington, KY)
- **Responsibilities** **JOB SUMMARY:** The Bariatric Clinical Reviewer plays a crucial role in ensuring departmental compliance with MBSAQIP Data Registry and other ... credentialing agencies by efficiently and accurately extracting patient data from medical charts within Epic. This data is then used to document key departmental… more
- Magellan Health Services (Honolulu, HI)
- …services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness. + Provides telephone triage, crisis intervention and ... of treatment when requests for services do not meet medical necessity criteria. + Participates in network development including...Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience -… more
- Kelly Services (Plainsboro, NJ)
- **Pharmacovigilance QC Reviewer II** Location: Plainsboro, NJ Schedule: Hybrid role with at least 3 days/week onsite is expected Length 1 year Pay: 28:00 **Job ... Level: Minimum Bachelor's degree, HCP degree is required eg, pharmacist or nurse ; advanced degree preferred * Experience Level: 3+ Years of in Pharmacovigilance… more
- ManpowerGroup (Columbia, SC)
- …to effectively communicate with members and healthcare providers. **Key Responsibilities** ✔ ** Medical Review & Utilization Management (80%)** + Perform ... Teams **Job Overview** We are seeking a **Utilization Management Nurse or Licensed Social Worker** to perform medical...medical reviews using established criteria and guidelines. + Review medical claims and determine reasonable charge… more
- Centene Corporation (Austin, TX)
- … claim reviews to ensure compliance with coding guidelines through a comprehensive review and analysis of claims, medical records, claims history, state ... and health plan provider calls. + Develop and maintain review guidelines for Corporate medical coding reviews....a managed care organization preferred LPN - Licensed Practical Nurse - State Licensure required or RN - Registered… more
- SSM Health (MO)
- …Specialist + Graduate of accredited school of nursing, PA, NP, or medical school, or Associate's degree and Certified Clinical Documentation Specialist (CCDS) ... the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate diagnosis review group (DRG) assignment, risk of mortality (ROM), and severity of… more
- HCA Healthcare (Brooksville, FL)
- …growth, we encourage you to apply for our RN Registered Nurse Float Pool Med Surg PCU PRN opening. We review all applications. Qualified candidates will be ... have the PRN career opportunities as a(an) RN Registered Nurse Float Pool Med Surg PCU PRN...Nursing Administrator (PCCN), or Board Certified Cardiac / Vascular Nurse , or Board Certified Medical Surgical Registered… 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:** ... Repayment Program. To learn more about program eligibility, application process and expectations please review the Nurse Corp Loan Repayment page: Apply to the … more
- HCA Healthcare (Largo, FL)
- …nurses set us apart from any other healthcare provider. We are seeking a(an) Registered Nurse RN Float Pool Med Surg to join our healthcare family. **Benefits** ... passion for patient care. Apply today for our Registered Nurse RN Float Pool Med Surg opportunity....Care Nursing Administrator (PCCN), Board Certified Cardiac / Vascular Nurse , Board Certified Medical -Surgical Registered Nurse… more