- Magellan Health Services (Boise, ID)
- …supervision. Project management skills and demonstrated experience. General Job Information Title Quality Clinical Reviewer ( Remote - Must live in Idaho) ... clinical experience along with an Associates degree and RN licensure in place of the Bachelors degree and...- Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse , State… more
- Prime Therapeutics (Columbus, OH)
- …position has managerial and clinical oversight of the Clinical Pharmacist and Registered Nurse Review Team, playing a key role in medical and ... drives every decision we make. **Job Posting Title** Supervisor Clinical Pharmacist Review - Remote ...+ Drives the daily performance of a team of Clinical Pharmacist and Registered Nurse … more
- Houston Methodist (Houston, TX)
- ** Clinical Documentation Specialist - 100% Remote ... experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - ... RN - At least five years of recent clinical experience caring for adults in an acute care...and/or Compact State Licensure within 60 days **OR** + RN -Temp - Registered Nurse -… more
- MetroHealth (Cleveland, OH)
- …socioeconomic backgrounds Preferred: Currently licensed or licensed by endorsement as a LPN, Registered Nurse , MD or MD equivalent. Minimum 5 years acute ... Level Reviewer with a strong understanding of disease processes, clinical indications and treatments, provider documentation requirements according to the rules… more
- RWJBarnabas Health (Oceanport, NJ)
- Clinical Appeals, RN , RemoteReq #:0000173624 Category:Billing/Collections/Registration Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate Services ... Department:Appeals Location: Remote , 2 Crescent Place, Oceanport, NJ 07757 Job Overview:...for managing medical denials by conducting a comprehensive analytic review of clinical documentation to determine if… more
- PeaceHealth (Vancouver, WA)
- **Description** PeaceHealth is seeking a RN Clinical Data Abstractor - Quality Outcomes for a Part Time, 0.50 FTE, Day position. The salary range for this job ... abstraction, data analysis and reporting, and data integrity Credentials + Required: Registered Nurse and + Preferred: Certified Professional in Healthcare… more
- Magellan Health Services (Baton Rouge, LA)
- …Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt ... results and/or corrective action plans. Other Job Requirements Responsibilities RN /BSN or clinical credentials in a behavioral...necessity criteria. General Job Information Title Clinical Reviewer III (Baton Rouge, LA or Remote … more
- Chenega Corporation (NM)
- …a health care field or Certified Professional in Healthcare Quality (CPHQ) preferred. + Registered Nurse or Licensed Clinical Social Worker, with current ... Professional Services** ' company, is looking for a fully remote ** Clinical Quality Reviewer ** to...and URAC standards for consistency. Supports activities of peer review and quality and safety committees. Our company offers… more
- CareFirst (Baltimore, MD)
- …complications. **QUALIFICATIONS:** **Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic...and mandates. + Organizes the appeal case for physician review by compiling clinical , contractual, medical policy… more
- Actalent (Atlanta, GA)
- Actalent is currently hiring for Remote Utilization Review RNs! Job Description: + Reviewing authorization requests + Utilizing evidence-based criteria and ... to providers to request additional details if applicable. Qualifications: + Active RN License + Prior Utilization management/Concurrent review experience +… more
- Molina Healthcare (MI)
- …effective operations that drive change. + Functions as key lead for clinical chart review /abstraction and team management. This includes qualitative analysis, ... **Job Description** **Job Summary** The Director, Clinical Data Acquisition is responsible for the implementation,...Certified Professional in Health Quality (CPHQ) * Nursing License ( RN may be preferred for specific roles) * Certified… more
- HCA Healthcare (Corpus Christi, TX)
- …career path, we encourage you to apply for our Registered Nurse Clinical Reviewer PRN opening. We review all applications. Qualified candidates will ... **Introduction** **Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer...REMOTE position.** **What qualifications you will need:** + ** Registered Nurse , prefer at least one year… more
- Providence (Beaverton, OR)
- …Nursing or Health Education + Within six months of hire date: Current unencumbered Registered Nurse License in Washington State + Case Management Experience (EX. ... the best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** + Support the commercial insurance… 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 ... an experienced RN Clinical Quality Review Specialist for a remote position** **ICD10...and top clinical outcomes. **Minimum Qualifications** + ** Registered Nurse with current license from the… more
- Trinity Health (Livonia, MI)
- …or Nursing or equivalent in experience. Must possess one of the below: + Current Registered Nurse ( RN ) License + Registered Health Information ... Ensures all compliance and regulatory standards are met. Ensures that direct reports perform clinical validation as part of the review process and remain current… more
- CareFirst (Cumberland, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider ... technology. + Must possess excellent verbal and written communication skills. **Licenses/Certifications** : RN - Registered Nurse - State Licensure And/or… more
- Providence (WA)
- …for this position include:** + Degree in Nursing + Oregon Registered Nurse License + 5+ years clinical experience (Nursing) **Preferred qualifications for ... must empower them._** **Providence Health Plan is calling a Clinical Nurse Auditor, HEDIS who will:** +...Information Set (HEDIS) program + Conduct Audits, which include review of outpatient medical records, hospital records, clinical… more
- UPMC (Pittsburgh, PA)
- …Maintain or exceed designated quality and production goals. Maintain employee/insured confidentiality. + Registered Nurse ( RN ). + Bachelor of Science in ... UPMC Health Plan is looking for an Intermediate Clinical Auditor/Analyst to join the Quality Assurance team!...CCA, CCS, CCS-P, CRC) or AHFI designation required. + Registered Nurse ( RN ) + Act… more
- AdventHealth (Altamonte Springs, FL)
- …care . 2 years CDI experience . Current active State license as a Registered Nurse , Nurse Practitioner, Physician's Assistant or an unlicensed physician ... for inpatients, sending/presenting opportunities for improved documentation compliance to physicians, nurse practitioners and other clinical team members. .… more
- HCA Healthcare (Corpus Christi, TX)
- …career path, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. We review all applications. Qualified candidates will be ... **Introduction** Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer...REMOTE position.** **What qualifications you will need:** + ** Registered Nurse , prefer at least one year… more
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