- Northeast Georgia Health System, Inc (Gainesville, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:8 Hr Morning - AfternoonNortheast Georgia Health System is rooted in a foundation of improving the health ... policy and procedure.Collaborates and communicates with the patient/family, Primary Nurse , Patient Care Coordinator, Physician, Referral Source, and Hospice… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:8 Hr Morning - AfternoonNortheast Georgia Health System is rooted in a foundation of improving the health ... policy and procedure.Collaborates and communicates with the patient/family, Primary Nurse , Patient Care Coordinator, Physician, Referral Source, and Hospice… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:10 Hr Morning - AfternoonNortheast Georgia Health System is rooted in a foundation of improving the ... significant others. Minimum Job QualificationsLicensure or other certifications: Registered Nurse in Georgia; Current BLS certificationEducational Requirements: Associates DegreeMinimum… more
- Careerbuilder-US (Chatham, PA)
- …program growth! This organization is accredited by the Joint Commission and Medicare . The clinical staff undergo extensive home health care training, annual ... competencies review , as well as professional development, a clinical advancement program and lifelong learning on the most cutting-edge clinical procedures. With an… more
- Pacer Staffing (Atlanta, GA)
- …Provides Disease Management (DM) services to TRICARE beneficiaries. . The DM nurse will collaboratively assess, plan, implement, coordinate, monitor and evaluate the ... the beneficiary to successfully manage their chronic condition. . The DM nurse will partner with the interdisciplinary care team to identify appropriate care… more
- Pacer Staffing (Atlanta, GA)
- …services as clinically appropriate and according to TRICARE policy. Conducts clinical review for requested services particular to the ECHO according to policy, ... high-profile or sensitive issues to the Medical Director for review . Functions as an advocate for the beneficiary by...States, as a Licensed Clinical Social Worker or Registered Nurse US Citizenship Must be able to receive a… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …responsible for completing the Medical Policy activities outlined in BCBSLA's Medicare Advantage Medical Policy Development Policies & Procedures locating, tracking ... heavy workloads accurately. **Licenses and Certifications** + Health Services\RN - Registered Nurse - State Licensure And/or Compact State Licensure to practice in… more
- Elevance Health (South Portland, ME)
- **Clinical Review Nurse I - Medicare Part A** National Government Services is a proud member of Elevance Health's family of brands. We administer government ... pm EST or CST. Hours are flexible.** The **Clinical Review Nurse I** is responsible for reviewing...experience is a plus. + Prior experience with claim review of Medicare helpful. + CMS (Centers… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... required to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer RN II, under the purview the Utilization Management (UM)… more
- Zelis (Morristown, NJ)
- Position Overview: The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical ... billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... procedures, and facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely… more
- CDS Life Transitions (Webster, NY)
- Summary: Utilization Management Reviewer (UR) is the critical evaluation of health care services provided to members using an integrated approach to determine the ... costs and monitoring quality of care. The Utilization Management Reviewer will play a key role in conducting these...and medical necessity of those services + Compile and review the necessary documents and clinical records to effectively… 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 ... UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063,...to enroll eligible individuals who are either Medicaid or Medicaid/ Medicare recipients and optimize their ability to remain in… more
- Zelis (TX)
- Position Overview: The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews ... AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for… more
- Molina Healthcare (Long Beach, CA)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- The Cigna Group (Bloomfield, CT)
- …effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and ... Medical Directors when services do not meet criteria or require additional review . + Participation in staff meetings, regular trainings and other collaborative… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 240830-5613FP-001 Location Middletown, CT Date Opened 9/5/2024 12:00:00 AM Salary ... - is accepting applications for one (1) full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) position, in Middletown,… more
- InnovaCare (San Juan, PR)
- …to the business. MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization ... visits to Acute, SNF, and Rehabilitation Inpatient facilities to concurrently review admissions and continued stay to determine appropriate Utilization, Quality… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the largest… more
- US Tech Solutions (Chicago, IL)
- …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... clinical policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. + Reviews… more
