- CHRISTUS Health (Wake Village, TX)
- …Advisor or CMO when discrepancies are present. * Performs the initial clinical medical necessity review utilizing evidence-based criteria and enters into ... ongoing management of patients in Observation status to include repeated review of clinical and opportunities for conversion to inpatient status. * Works closely… more
- Dana-Farber Cancer Institute (South Boston, MA)
- …funding types including federal, industry, foundation, donor, institutional, chargeback, and clinical trials. The RA collaborates with faculty and researchers on the ... Accounts Payable, Research Administration, Special Funds, Grants and Contracts, the Clinical Trials Office, Office of General Counsel, and the Innovations Office.… more
- Eurofins USA Food Testing (North Platte, NE)
- …discovery pharmacology, forensics, advanced material sciences and in the support of clinical studies, as well as having an emerging global presence in Contract ... Group also has a rapidly developing presence in highly specialised and molecular clinical diagnostic testing and in-vitro diagnostic products. In over just 30 years,… more
- Lovelace Women's Hospital (Alameda, NM)
- …the state recognized as a Center of Excellence in Robotic Surgery by Surgical Review Corporation. We believe healthcare is a team sport and every player has ... Diploma or GED equivalent Graduate of accredited Surgical Technology program or clinical -based program Six (6) months experience in an operating room or ambulatory… more
- CommonSpirit Health Mountain Region (Durango, CO)
- …flourish and leaders who care about your success. Assist with training and coordinating clinical review and quality assurance. Lead and review the ... of clinical care and documentation practices related to patients/residents. Review and evaluate quality data to determine areas needing improvement. Review… more
- Elevance Health (Miami, FL)
- ** Clinical Review Nurse I - Medicare Part A & B** National Government Services is a proud member of Elevance Health's family of brands. We administer government ... Friday 8 am - 5 pm EST or CST. Hours are flexible.** The ** Clinical Review Nurse I** is responsible for reviewing and making medical determinations as to whether… more
- Elevance Health (Indianapolis, IN)
- ** Clinical Review Nurse Sr.** National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for ... Monday through Friday 8 am - 4:30 EST. Hours are flexible.** The ** Clinical Review Nurse Sr** . is responsible for coordinating and overseeing the work of… more
- Centers Plan for Healthy Living (Margate, FL)
- Clinical Review RN 5297 W Copans Rd, Margate, FL 33063, USA Req #460 Tuesday, November 5, 2024 Centers Plan for Healthy Living's goal is to create the ultimate ... plans they need for healthy living. Job Summary: We are currently looking for Clinical Review RN's to join our team. These positions are responsible for the … more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review Clinical Review (CR) 3 Team Lead will assist the Director of UR and Associate Director of UR with daily staff mentoring, ... experience is required. Must possess comprehensive and broad knowledge of complex clinical and medical concepts and demonstrate overall proficiency in clinical … more
- St. Luke's Health System (Boise, ID)
- **Overview** At St. Luke's, our dedicated team of Clinical Review Nurses strive to build a positive, supportive, and inclusive culture that delivers exceptional ... **Category** _Nursing - RN and Leadership_ **Work Unit** _Clinical Review Management System Office_ **Position Type** _Full-Time_ **Work Schedule** _VARIABLE_… more
- Prime Therapeutics (Columbus, OH)
- …our passion and drives every decision we make. **Job Posting Title** Supervisor Clinical Pharmacist Review - Remote in California **Job Description Summary** ... position has managerial and clinical oversight of the Clinical Pharmacist and Registered Nurse Review Team, playing a key role in medical and pharmacy… more
- Trinity Health (Livonia, MI)
- …**Shift:** **Description:** Trinity Health at Home is seeking an experienced RN remote Clinical Quality Review Specialist with ICD10 HCS-D certification which is ... of hire **Trinity Health at Home is seeking an experienced RN Clinical Quality Review Specialist for a remote position** **ICD10 HCS-D certification which is… more
- Penn Medicine (Bala Cynwyd, PA)
- …our future each day. Are you living your life's work? Summary: + The Clinical Documentation Review Specialist is responsible for collaborating with clinicians to ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …a member and provider call center, provider correspondence and appeals, clinical review , member correspondence and reconsiderations, enrollment, claims ... FEP is BCBSMA's single largest account Position Summary: The RN Clinical Provider Post Service Review Manager , led by a Registered Nurse, is responsible for… more
- Hackensack Meridian Health (Brick, NJ)
- …educate and support appropriate documentation for coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed ... through focused clinical audits. Trend data obtained from reports and review results with managers. + Identify areas for improvement for team members that… 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, ... on workplace flexibility. **Must have a New York State clinical license.** **Position Purpose:** Performs clinical reviews...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… 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
- The Cigna Group (Bloomfield, CT)
- …effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and ... when services do not meet criteria or require additional review . * Participation in staff meetings, regular trainings and...residency Compact license a plus * Minimum 2-3 years clinical experience. * Experience in regulated managed care setting… more
- Centene Corporation (Sacramento, CA)
- …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, ... years of related experience. 2+ years of acute care experience required. + Clinical knowledge and ability to determine overall health of member including treatment… more
- Molina Healthcare (NE)
- …overturn rates. * Provides strategic leadership for both pre-pay and post-pay clinical review programs to grow overpayment identification, drive savings results, ... has oversight for creation, publication, and maintenance of DRG Validation clinical policies to support Clinical review program and cases with high potential… more
