- CareFirst (Cumberland, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider ... programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Medical Review **Equal Employment Opportunity** CareFirst… 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 ... issues to the Director of the certified operation, Hospice Clinical Director, and the Nurse Manager for...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 ... issues to the Director of the certified operation, Hospice Clinical Director, and the Nurse Manager for...clinical audits. Trend data obtained from reports and review results with managers. + Identify areas for improvement… 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
- 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, ... and cost effectiveness of medical care. + Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in… more
- Actalent (Atlanta, GA)
- Actalent is currently hiring for Remote Utilization Review RNs! Job Description: + Reviewing authorization requests + Utilizing evidence-based criteria and making a ... if applicable. Qualifications: + Active RN License + Prior Utilization management/Concurrent review experience + Experience with MCG Why Actalent? + Work with a… 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 ... clinical care and documentation practices related to patients/residents. Review and evaluate quality data to determine areas needing...of the home health and/or hospice patient. + Registered Nurse + Valid CO Driver's License. + BLS Sedentary… more
- R1 RCM (Boise, ID)
- …AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to ... production-drive position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal… more
- Prime Therapeutics (Columbus, OH)
- …Description Summary** This position has managerial and clinical oversight of the Clinical Pharmacist and Registered Nurse Review Team, playing a key ... drives every decision we make. **Job Posting Title** Supervisor Clinical Pharmacist Review - Remote in California...the clinical performance of a team of Clinical Pharmacist and Nurse Reviewers while supporting… more
- HCA Healthcare (San Antonio, TX)
- …step in your career path, we encourage you to apply for our Clinical Nurse Coord Nurse opening. We review all applications. Qualified candidates will be ... **Description** **Introduction** Do you have the career opportunities as a(an) Clinical Nurse Coord Nurse you want in your current role? We invest in what… more
- HCA Healthcare (Austin, TX)
- …step in your career path, we encourage you to apply for our Float Pool Clinical Nurse Coordinator opening. We review all applications. Qualified candidates ... **Description** **Introduction** Do you have the career opportunities as a(an) Float Pool Clinical Nurse Coordinator you want in your current role? We invest in… more
- HCA Healthcare (Austin, TX)
- …step in your career path, we encourage you to apply for our Dialysis Clinical Nurse Coordinator opening. We review all applications. Qualified candidates ... **Description** **Introduction** Do you have the career opportunities as a(an) Dialysis Clinical Nurse Coordinator you want in your current role? We invest in… more
- HCA Healthcare (Austin, TX)
- …in your career path, we encourage you to apply for our Emergency Room Clinical Nurse Coordinator opening. We review all applications. Qualified candidates ... **Introduction** Do you have the career opportunities as an Emergency Room Clinical Nurse Coordinator you want in your current role? We invest in what… more
- HCA Healthcare (San Antonio, TX)
- …next step in your career path, we encourage you to apply for our ICU Clinical Nurse Coordinator opening. We review all applications. Qualified candidates ... **Description** **Introduction** Do you have the career opportunities as a(an) ICU Clinical Nurse Coordinator you want in your current role? We invest in what… more
- HCA Healthcare (San Antonio, TX)
- …step in your career path, we encourage you to apply for our Medical ICU Clinical Nurse Coordinator opening. We review all applications. Qualified candidates ... **Introduction** Do you have the career opportunities as a(an) Medical ICU Clinical Nurse Coordinator you want in your current role? We invest in what… more
- HCA Healthcare (Myrtle Beach, SC)
- …step in your career path, we encourage you to apply for our RN Medsurg Clinical Nurse Coordinator opening. We review all applications. Qualified candidates ... **Introduction** Do you have the career opportunities as a **RN Medsurg Clinical Nurse Coordinator** you want in your current role? We invest in what… more
- HCA Healthcare (Richmond, VA)
- …step in your career path, we encourage you to apply for our Psychiatric Clinical Nurse Coordinator opening. We review all applications. Qualified candidates ... **Description** **Introduction** Do you have the career opportunities as a(an) Psychiatric Clinical Nurse Coordinator you want in your current role? We invest in… more
- HCA Healthcare (Plano, TX)
- …in your career path, we encourage you to apply for our Ortho Trauma PCU Clinical Nurse Coordinator opening. We review all applications. Qualified candidates ... **Description** ** Clinical Nurse Coordinator / CNC -...**Description** ** Clinical Nurse Coordinator / CNC - Orthopedic Trauma PCU**...have the career opportunities as an Ortho Trauma PCU Clinical Nurse Coordinator you want in your… more
- HCA Healthcare (Plano, TX)
- …in your career path, we encourage you to apply for our Surgical Oncology Clinical Nurse Coordinator opening. We review all applications. Qualified candidates ... **Description** ** Clinical Nurse Coordinator - Surgical Oncology** **Shift: Full time - Nights** **Location: Medical City Plano Hospital** **Introduction** Do… more
- HCA Healthcare (Plano, TX)
- …in your career path, we encourage you to apply for our Ortho Trauma PCU Clinical Nurse Coordinator opening. We review all applications. Qualified candidates ... **Description** ** Clinical Nurse Coordinator / CNC -...**Description** ** Clinical Nurse Coordinator / CNC - Orthopedic Trauma PCU**...have the career opportunities as an Ortho Trauma PCU Clinical Nurse Coordinator you want in your… more