- Actalent (Atlanta, GA)
- Actalent is currently hiring for Remote Utilization Review RNs! Job Description: + Reviewing authorization requests + Utilizing evidence-based criteria and ... if applicable. Qualifications: + Active RN License + Prior Utilization management/Concurrent review experience + Experience with MCG Why Actalent? + Work with a… more
- 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
- Providence (WA)
- …retain the best people, we must empower them._** **Providence Health Plan is calling a Clinical Nurse Auditor, HEDIS who will:** + Be responsible for conducting ... Information Set (HEDIS) program + Conduct Audits, which include review of outpatient medical records, hospital records, clinical...position include:** + Degree in Nursing + Oregon Registered Nurse License + 5+ years clinical experience… 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
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Quality Review Nurse (RN) is to evaluate clinical quality and procedures within the Clinical ... Utilization Management, Case Management, Claims, Quality Management and Compliance. The Nurse , Quality Review position develops procedures and reinforce quality… more
- Centene Corporation (Tallahassee, FL)
- …workplace flexibility. **Must be a current Florida resident!!** **Centene is currently seeking a Clinical Review Nurse - Prior Authorization to join our ... 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,… more
- Rising Medical Solutions (Chicago, IL)
- …was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment. ... maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee...neuro, rehab, or ER procedures + 3-5 years of clinical experience in acute care, surgery and/or orthopedic +… 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 ...the clinical performance of a team of Clinical Pharmacist and Nurse Reviewers while supporting… more
- Centene Corporation (Madison, WI)
- …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
- System One (Baltimore, MD)
- ALTA IT Services is staffing a contract opportunity for a Clinical HEDIS Specialist support a leading health insurance customer. The main duties include conducting ... other needs within the Quality Department. Pay: $37/HR 90% Remote May need to go onsite in Baltimore, MD...found. Correct errors identified through over-read process, including a re- review of charts that may contain similar errors. +… 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, ... competitive benefits including a fresh perspective on workplace flexibility. **Fully Remote position that requires a CA RN Licensure.** **Position Purpose** :… more
- Veterans Affairs, Veterans Health Administration (Prescott, AZ)
- …The duties of the position include but are not limited to the following: The Nurse III Remote Patient Monitoring (RPM) Home Telehealth (HT) Registered Nurse ... the right time. The HT RN works to improve clinical outcomes and access to care while reducing complications,...Provides initial and ongoing comprehensive assessment to include a review of systems which establishes a comprehensive plan of… more
- Medical Mutual of Ohio (OH)
- …a drug-free workplace and perform pre-employment substance abuse and nicotine testing._ \#LI- REMOTE **Title:** _Registered Nurse Clinical Appeal & Claim_ ... provider community, explaining processes for accessing health plan to perform clinical review , identifying appropriate community resources, or otherwise… more
- AmeriHealth Caritas (Florence, SC)
- ** REMOTE | Care Manager II Registered Nurse (BSN) - Foster Care Program -SC** Location: Florence, SC Primary Job Function: Medical Management ID**: 34390 **Job ... Counties preferred are York, Florence, Darlington, Williamsburg and Horry. RN required. ** Remote to qualified candidates living in South Carolina with a preference… more
- Cleveland Clinic (Lakewood, OH)
- …and the Governing Body of the applicable hospitals. **CNS** + Currently licensed as a Clinical Nurse Specialist in applicable state(s). + Must be licensed as an ... the office, and virtual visits. The position is not remote , but there may hybrid opportunities in the future...RN in applicable state(s). + National certification as a Clinical Nurse Specialist by nationally accredited organization… more
- R1 RCM (Chicago, IL)
- …AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to ... basic computer skills is essential for excelling in this remote production-drive position. **Here's what you will experience working...position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review… more
- HCA Healthcare (Mcallen, TX)
- …your career path, we encourage you to apply for our Clinical Nurse Coordinator Emergency Room FSED opening. We review all applications. Qualified candidates ... **Introduction** Do you have the career opportunities as a(an) Clinical Nurse Coordinator Emergency Room FSED you...services into the Rio Grande Valley with our three remote ERs in McAllen/Mission, Edinburg, and San Juan. Our… more
- Geisinger (Danville, PA)
- Job Summary The Clinical Documentation Improvement Program (CDI) is designed to improve the physician's documentation in the patient's medical record, supporting the ... 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
- Elevance Health (Atlanta, GA)
- **Diagnosis Related Group Clinical Validation Auditor-** **Registered Nurse ** **Location:** This position will work a hybrid model ( remote and office). Ideal ... miles of one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor** is responsible for auditing inpatient medical records to ensure… more
- HCA Healthcare (Corpus Christi, TX)
- …your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer PRN opening. We review all applications. Qualified candidates will be ... **Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer PRN you want in...Center Bay Area!** **Job Summary and Qualifications** **The Quality Review Nurse position encompasses multiple responsibilities including… more