- HCA Healthcare (Houston, TX)
- …set us apart from any other healthcare provider. We are seeking a(an) Registered Nurse RN Clinical Reviewer to join our healthcare family. **Benefits** The ... and empowers their passion for patient care. Apply today for our Registered Nurse RN Clinical Reviewer opportunity. **Job Summary and Qualifications** The… more
- HCA Healthcare (Corpus Christi, TX)
- …path, we encourage you to apply for our Registered Nurse Clinical Reviewer PRN opening. We review all applications. Qualified candidates will be contacted ... **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
- Elevance Health (Chicago, IL)
- …clinicians and business leaders passionate about transforming American healthcare delivery. ** Nurse Reviewer I** **Location:** **Illinois. This is a remote ... miles of our Elevance Health PulsePoint location in** **Chicago, Illinois** **.** The ** Nurse Reviewer I** is responsible for conducting preauthorization, out of… more
- Elevance Health (San Juan, PR)
- …organization, providing information technology and business operations services for health plans._ ** Nurse Reviewer I** **Location:** This position will work a ... time zones that the unit will be supporting. The ** Nurse Reviewer I** is responsible for conducting...meets medical necessity criteria or requires additional medical necessity review . + Conducts initial medical necessity review … more
- Medical Mutual of Ohio (OH)
- …of services and procedures. Manages initial, concurrent, and retrospective review of cases, including appeals, through evaluation of clinical information ... by the Ohio State Nursing Board. . 3 years as a Registered Nurse with a combination of clinical and utilization/case management experience in medical specialty… more
- Idaho Division of Human Resources (ID)
- Program Manager - Nurse Reviewer - MED Posting Begin Date: 2025/01/14 Posting End Date: 2025/01/28 Category: Program Management Sub Category: Management Work ... Managerto oversee sevenstatewideteams of registered nurses. We are seeking a registered nurse who has a knack for navigating the intersection between clinical… more
- Lee County Board of County Commissioners (Fort Myers, FL)
- Fire Plan Reviewer Print (https://www.governmentjobs.com/careers/leecounty/jobs/newprint/4735880) Apply Fire Plan Reviewer Salary $24.86 - $52.12 Hourly ... + Benefits + Questions Description JOIN OUR TEAM AS A FIRE PLAN REVIEWER ! Lee County Community Development is committed to ensuring the safety and compliance… more
- Commonwealth Care Alliance (Boston, MA)
- …of community-based assessments for CCA members and ongoing tracking and monitoring. The RN MDS Reviewer is a member of the Minimum Data Set (MDS) Clinical Review ... team of the Care Planning Unit. The RN MDS Reviewer supports successful completion and submission of the MDS...form based on diagnoses / information gathered from record review . + Prepares printed MDS forms for data entry.… more
- Apex Health Solutions (Houston, TX)
- …as well as carrying out day today pre-authorization functions. The Utilization Review Nurse will also be responsible for issuing pre-authorization ... as a contact and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM Reviewer will be responsible for… more
- HCA Healthcare (Corpus Christi, TX)
- …next step in your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. We review all applications. Qualified candidates ... Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your...including Core Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews & is… 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 improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have complex ... the following personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part of a highly dedicated and motivated team of professionals,… more
- Nuvance Health (Poughkeepsie, NY)
- …the support of a thorough orientation program. *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, ... dashboard on quality and process measures .Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as appropriate. 8.Provides… more
- Magellan Health Services (Johnstown, PA)
- …skills and demonstrated experience. General Job Information Title Quality Clinical Reviewer , Licensed/Remote in PA (Cambria Cty) Grade 25 Work Experience - ... Therapist - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt License and Certifications - Preferred… more
- Magellan Health Services (Honolulu, HI)
- …quality of care. General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience - Required Clinical Work Experience - ... - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt License and Certifications - Preferred… more
- SSM Health (MO)
- …services rendered. The CDI Specialist assesses clinical documentation through extensive review of the medical record, interaction with physicians, nursing staff, ... accurate clinical documentation and correct negative trends. Communicates with physicians, nurse practitioners, case managers, coders and other members of the care… more
- SSM Health (MO)
- …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
- SUNY Upstate Medical University (Syracuse, NY)
- …the Patient Relations department with patient complaints that require quality review and/or Risk oversight. Minimum Qualifications: Registered Nurse , NYS ... Job Summary: High-level clinical review of patients admitted to the University Hospital...risk identification and referral to clinical departments for ongoing review of quality improvement focused on the support of… more
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, ... required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate,...process. + The Contractor performing as the License Practical Nurse (LPN) Utilization Reviewer (UR) shall make… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing provider claims appeals, validating ... position requires strong clinical and medical coding skills to review provider claim appeals for medical necessity, appropriate coding,...integral part of the Clinical Appeals team, the Appeals Nurse Reviewer will serve as a liaison… more
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