- University Health (Seguin, TX)
- …hospital experience preferred. Work experience in case management, utilization review , or hospital quality assurance experience is preferred. LICENSURE/CERTIFICATION ... Current license from the Board of Nurse Examiners of the State of Texas to practice...the State of Texas to practice as a registered nurse is required. National certification in related field is… more
- University Health (Pleasanton, TX)
- …full-time hospital experience preferred. Work experience in case management, utilization review or hospital quality assurance experience is preferred. Must complete ... hire date. LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice...the State of Texas to practice as a registered nurse is required. National certification in related field is… more
- Liberty Healthcare Corporation (Boise, ID)
- Registered Nurses are encouraged to consider a part-time remote Nurse Reviewer position with Liberty Healthcare Corporation. Liberty Healthcare operates a ... for various publicly funded health and human services. As Liberty's Nurse Reviewer , you will apply your nursing expertise to determine eligibility for… more
- Chenega Corporation (Rockville, MD)
- …**Chenega Professional Services Strategic Business Unit** company, is looking for a Nurse Practitioner-Contract Medical Reviewer (CMR) to support the Department ... medicine, as this aligns closely with the types of cases we review . Clinicians with backgrounds in Internal Medicine, Family Medicine, Emergency Medicine, or… more
- Elevance Health (Los Angeles, CA)
- …coverage (Sat & Sun 8am-12pm CST, with a comp day during the week) The ** Nurse Reviewer I** is responsible for conducting preauthorization, out of network and ... on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners with… more
- Evolent (Lansing, MI)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- AmeriHealth Caritas (Washington, DC)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines ... on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the appropriateness of services, identifies care coordination opportunities,… more
- Hartford HealthCare (Hartford, CT)
- …The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation, ... registry activities, including program teleconferences and meetings. Maintains Surgical Clinical Reviewer (SCR) certification on an annual basis, in accordance with… more
- Zelis (St. Petersburg, FL)
- …maintain claim review content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies and Dispute Rationales + Perform regulatory ... are. Position Overview At Zelis, the DRG Clinical Dispute Reviewer role is responsible for the resolution of facility...production and quality metric goals. What you'll do: + Review provider disputes for DRG Coding and Clinical Validation… more
- St. Luke's University Health Network (Bethlehem, PA)
- …regardless of a patient's ability to pay for health care. The Admission's Clinical Reviewer is responsible for the comprehensive medical review and screening of ... and responds to all inquiries for admission to ARC + Completes thorough review of documentation and information and assesses a patient's appropriateness for ARC… 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 ... their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Chenega Corporation (Rockville, MD)
- …Services Strategic Business Unit** company, is looking for a Physician- Contract Medical Reviewer (CMR) to support the Department of Health and Human Services (HHS), ... closely with the Government and Contractor team trainers, physicians, and nurse practitioners. + Support management, administration, data, communication, and other… more
- Zelis (FL)
- …interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay ... AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for… more
- Nuvance Health (Poughkeepsie, NY)
- *Description* Summary: *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, Risk Management, Infection ... program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as appropriate.… more
- PruittHealth (Columbia, SC)
- **RN experienced with OASIS and certified ICD 10 Reviewer ** **- HOME HEALTH SERVICES** **Must have ICD-10 Certification** **Join the PruittHealth @Home family, where ... CERTIFICATION, AND EDUCATIONAL REQUIREMENTS** + Current, active, and unrestricted Registered Nurse (RN) licensure in the state of practice **Family Makes Us… more
- SSM Health (IL)
- …the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate diagnosis review group (DRG) assignment, risk of mortality (ROM), and severity of ... documentation in the health record. + Attends department meetings to review documentation related issues. Conducts independent research to promote knowledge of… more
- SSM Health (MO)
- …to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, observed rate/expected rate ... (O/E ratios), industry trends, variable and diagnosis review group (DRG) frequency. + Serves as a liaison...- Regional MSO Credentialing + Or + Registered Professional Nurse (RN) - Illinois Department of Financial and Professional… more
- Zelis (NJ)
- …Zelis standards regarding privacy What you'll bring to Zelis: + Registered Nurse licensure preferred + Inpatient Coding Certification required (ie, CCS, CIC, RHIA, ... RHIT) + 5+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred + Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers + Experience and working knowledge of Health… more
- HCA Healthcare (Orlando, FL)
- …us apart from any other healthcare provider. We are seeking a(an) Registered Nurse Coordinator Bariatrics to join our healthcare family. **Benefits** UCF Lake Nona ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...coordinate education and communication related to regulator updates. **CLINICAL REVIEWER RESPONSIBILITIES** : + MBS clinical reviewer … more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... information regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team. Whether you're working in… more
