- Altru Health (East Grand Forks, MN)
- …participating in restructuring of current and new programs. Performs utilization review when required. Collaborates with Primary Care Provider (PCP) regarding the ... to meet the needs of the department/organization. Certification: Licensed Clinical Social Worker (LCSW) | North Dakota Board of...to Start Date | HR Primary Sources Licensed Independent Clinical Social Worker | Minnesota Board of Social Work… more
- Altru Health (Thief River Falls, MN)
- …diagnosis, symptoms and physician orders and documents per chart and review standards. Coordinates treatment schedules with disciplines using appropriate scheduling ... actions, as evidenced in reporting, staffing consultations and documentation. Provides clinical supervision to OTA in a collaborative manner following state… more
- Baptist Memorial (Memphis, TN)
- …education + Employee referral program Job Summary: Position: 3337 - Abstractor- Clinical Review Advanced Facility: BMHCC Corporate Office Department: HS ... (3) years? clinical experience in inpatient cardiovascular care setting. Clinical chart review and abstraction experience. Special Skills Preferred: Data… 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
- HCA Healthcare (Sun City Center, FL)
- …and more affordable to gain certifications and job skills. Apply today for our Clinical Review RN Coordinator Quality Management opening and continue to learn! ... learning is important to you, we encourage you to apply for our Clinical Review RN Coordinator Quality Management opening. Our team will promptly review … 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
- 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
- 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
- Trinity Health (Livonia, MI)
- …can be obtained within 6 months of hire. HCS-O is helpful. Remote position. ** Clinical Quality Review Specialist Position Summary - REMOTE** **RN Must be ... (COS-C) can be obtained within 6 months of hire.** The Clinical Quality Review Specialist is responsible processing and completing assigned quality and … more
- Hackensack Meridian Health (Little Falls, NJ)
- …educate and support appropriate documentation for coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed ... Bergen, and parts of Morris counties. The VHSNJ multidisciplinary clinical and support teams provide high quality care to...clinical audits. Trend data obtained from reports and review results with managers. + Identify areas for improvement… 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
- Prime Healthcare (Ontario, CA)
- …seeking new members to join our corporate team! Responsibilities VP Utilization Review and Clinical Denials Management will provide strategic leadership, ... direction and operational management for the Utilization Review and Clinical Denial Management teams. This position encompasses process oversight for all lines… more
- Centene Corporation (Raleigh, NC)
- …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 (Reno, NV)
- …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
- 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
- DRT Strategies, Inc. (Silver Spring, MD)
- …reports regarding assessment of safety data sufficiency, integrity, and quality to clinical review teams. + Perform comprehensive safety data analyses and ... provide written reports containing standardized safety tables and figures to clinical review teams. + Conduct in-depth safety analyses for specific safety… more
- University of Colorado (Aurora, CO)
- …and facility leadership. + Manages the Institute's outside medical process through clinical review and authorization of services. Assesses and recommends ... and facility leadership. + Manages the Institute's outside medical process through clinical review and authorization of services. Assesses and recommends… more
- Penn Medicine (Philadelphia, PA)
- …develop/upkeep efficiencies/synergies within the Clinical Documentation department + Enter clinical review data and related anticipated follow-up in the CDI ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- AdventHealth (Hinsdale, IL)
- …Resource Manager provides leadership and consultation to company facilities in the clinical review , evaluation and procurement of products and leads ... committees.** **The value you'll bring to the team:** + **Facilitates clinical teams to review utilization and options for product selection for our Great Lakes… more
