- Medical Mutual of Ohio (OH)
- …Advantage, Medicare Supplement, and individual plans. Under limited supervision, the Medicare Nurse Reviewer applies medical necessity guidelines in ... for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Responsibilities** + Evaluates clinical information… 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
- Chenega Corporation (NM)
- …Services** ' company, is looking for a fully remote **Clinical Quality Reviewer ** to ensure compliance with the contract, and program requirements for Clinical ... national, TRICARE, and URAC standards for consistency. Supports activities of peer review and quality and safety committees. Our company offers employees the… more
- MetroHealth (Cleveland, OH)
- …of additional comorbid conditions. Conducts concurrent and retrospective medical record review on defined patient populations to identify opportunities to improve ... minimum of 3 years of CDI experience or; - CDI Second Level Reviewer with a strong understanding of disease processes, clinical indications and treatments, provider… more
- Guthrie (Binghamton, NY)
- …prevention of patient populations through nursing-patient collaboration and patient education. This nurse performs the Medicare Annual Wellness Visit under the ... Summary The Wellness Nurse plays a key role in health promotion...autonomy in nursing practice. Preferred experience with care management/utilization review , and payer knowledge. RN considered. Education Completion of… more
- BAYADA Home Health Care (Wilmington, MA)
- …seeking a Registered Nurse (RN) to fill the position of **Home Health Nurse Manager** for our **Wilmington, MA** Medicare Certified home health office. This ... program. + Field mileage reimbursement. **As a Home Health Nurse Manager your day may look like this!** +...cohesive and consistent management of all field staff. + Review all clinical documentation to ensure consistent, accurate, high-quality… more
- Molina Healthcare (TX)
- …Certification, Association** Active and unrestricted Licensed Clinical Social Worker Registered Nurse , Compact nursing licensure _WORK HOURS 5 days / daytime work ... schedule, some weekends and holidays. *PREFERRED , Tues thru Saturday or Sunday thru Thursday._ To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Under general ... supervision,** **performs administrative functions in support of assigned utilization review or case management department. Receives and reviews correspondence from… 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)
- This position, the Nurse Case Manager Senior Analyst, through the case management process, will promote the improvement of health outcomes to members and assist ... for the transplant members assigned to their caseload. This will require review of clinical information and correspondence with facilities to make determinations on… 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
- Hackensack Meridian Health (Little Falls, NJ)
- …for coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed Medicare admission chart to determine ... in the system if inappropriate codes are identified. + Review each Hospice assessment to assure each CTI, 485...of the certified operation, Hospice Clinical Director, and the Nurse Manager for the appropriate operation. Demonstrates the ability… more
- Hackensack Meridian Health (Brick, NJ)
- …for coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed Medicare admission chart to determine ... in the system if inappropriate codes are identified. + Review each Hospice assessment to assure each CTI, 485...of the certified operation, Hospice Clinical Director, and the Nurse Manager for the appropriate operation. Demonstrates the ability… 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 Appeals & ... Utilization Management, Case Management, Claims, Quality Management and Compliance. The Nurse , Quality Review position develops procedures and reinforce quality… 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
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** **The Hackensack University Medical Center Night Shift RRT Nurse Practitioner or Physician Assistant performs the role utilizing the patient-centered ... practice. 5. Participates in APRN interviewing, credentialing, and peer review process as requested. 6. Participates in a minimum...staff leaders to support nursing-led protocols to enhance the nurse 's ability to function at their highest level of… more
- US Tech Solutions (May, OK)
- …clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews ... Care cases across all lines of business (Commercial and Medicare ). . Independently coordinates the clinical resolution with internal/external.... 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior… more
- CommonSpirit Health Mountain Region (Durango, CO)
- …leaders who care about your success. Assist with training and coordinating clinical review and quality assurance. Lead and review the appropriateness of clinical ... care and documentation practices related to patients/residents. Review and evaluate quality data to determine areas needing...of the home health and/or hospice patient. + Registered Nurse + Valid CO Driver's License. + BLS Sedentary… 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. ... team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance,… more
- Centene Corporation (Raleigh, NC)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... care to members + Provides feedback on opportunities to improve the authorization review process for members + Performs other duties as assigned + Complies with… more