- CareFirst (Cumberland, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider ... appeals that require medical review to determine if the claim...and written communication skills. **Licenses/Certifications** : RN - Registered Nurse - State Licensure And/or Compact State Licensure RN-VA,… more
- Rising Medical Solutions (Chicago, IL)
- …too. In fact, that's how our business was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark ... Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including...in acute care, surgery and/or orthopedic + Workers' Compensation medical bill review experience a major plus… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: Registered Nurse (RN) provides professional nursing care to patients within the practice, located in the Hill building of Upstate University Hospital. ... care while overseeing the work of the licensed practical nurse , and ancillary staff in the Practice. Triage ...REFILLS (sent electronically from pharmacies to the office) : Review to refill or deny all medications daily .… more
- Sedgwick Government Solutions (Orlando, FL)
- …Nurse Case Manager ( Remote - Strong Internal) 2024-1374 Orlando, FL, USA Medical Case Management Full Time Description Nurse Case Manager (Home Based) - ... + 3 years related clinical experience in discharge planning, oncology, utilization review /management to determine the necessity of medical services, behavioral… more
- Providence (WA)
- …Effectiveness and Data Information Set (HEDIS) program + Conduct Audits, which include review of outpatient medical records, hospital records, clinical lab and ... fill in for staff vacancies. **_Providence Health Plan welcomes remote work for applicants who reside in:_** + Washington...program evaluation, team facilitation, data analysis and or case review + Experience working as a Nurse … more
- CareFirst (Baltimore, MD)
- …mental health, psychiatric setting. **Preferred Qualifications:** + 2 years' experience in Medical Review , Utilization Management or Case Management at CareFirst ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of...and mandates. + Organizes the appeal case for physician review by compiling clinical, contractual, medical policy… more
- AmeriHealth Caritas (Florence, SC)
- ** REMOTE | Care Manager II Registered Nurse (BSN) - Foster Care Program -SC** Location: Florence, SC Primary Job Function: Medical Management ID**: 34390 ... Counties preferred are York, Florence, Darlington, Williamsburg and Horry. RN required. ** Remote to qualified candidates living in South Carolina with a preference… more
- LifePoint Health (Las Cruces, NM)
- …by applicable federal, state or local law./ **Job:** **Nursing* **Organization:** **Memorial Medical Center* **Title:** *Registered Nurse (RN) Case Manager - UM ... you are not just what you can do. Memorial Medical Center is a 199-bed hospital offering a spectrum...in the development of care, discharge planning and Utilization Review . * Utilization Management performs prospective, admissions, observation and… more
- 315 health (Warner Robins, GA)
- …confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and ... management of their health through continuous care programs like Remote Patient Monitoring and Chronic Care Management. Our team works fervently to anticipate the… more
- Actalent (Austin, TX)
- …and compare results to HEDIS standards and/or custom or other measure set standards + Review medical records and abstract data for HEDIS and other measure sets ... Actalent is currently hiring for Remote HEDIS Nurses (RN/LPN)! Job Description: + Lead data collection and abstraction for company quality measures, including HEDIS,… more
- Actalent (Austin, TX)
- …vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom * Review medical records and abstract data for HEDIS and other ... * Current RN or LPN license Work Environment This position will be fully remote . Candidate must have strong internet connection. Hours are Monday through Friday from… more
- Centene Corporation (Reno, NV)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... benefits including a fresh perspective on workplace flexibility. NOTE: This is a fully remote role. Preference will be given to applicants who (1) reside in the… more
- Centene Corporation (Sacramento, CA)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... a fresh perspective on workplace flexibility. **Location: Position is 100% remote . Candidate must have CA RN Licensure.** **Position Purpose:** Analyzes all… more
- State of Colorado (Denver, CO)
- Youth Corrections Medical Operations Coordinator ( Nurse V) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4573875) Apply Youth ... Corrections Medical Operations Coordinator ( Nurse V) Salary $108,540.00 - $151,968.00 Annually Location Denver Metro, CO Job Type Full Time Job Number IKA 02221… more
- Prime Therapeutics (Columbus, OH)
- …managerial and clinical oversight of the Clinical Pharmacist and Registered Nurse Review Team, playing a key role in medical and pharmacy management. Leads ... and drives every decision we make. **Job Posting Title** Supervisor Clinical Pharmacist Review - Remote in California **Job Description Summary** This position… more
- Veterans Affairs, Veterans Health Administration (Rutherfordton, NC)
- …VA Clinic in Rutherfordton, NC has an immediate availability for one (1) Nurse Practitioner ( Medical Director) for the Community-Based Outpatient Clinic Service. ... The Advanced Practice Nurse (APN) IV Chief Nurse - Medical Director practices in the...the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible… more
- Veterans Affairs, Veterans Health Administration (Roseburg, OR)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... families here for generations. General Description of Assigned Duties: The Certified Nurse Practitioner (NP) practices in Mental Health Service to provide a full… more
- Medical Mutual of Ohio (OH)
- …of service provided, length of stay and level of care + Extrapolates and summarizes medical information for physician review or other external review + ... Ohio State Nursing Board. Bachelor's degree preferred + 3 years' experience as a Registered Nurse in acute care, critical care, emergency medical or medical … more
- Banner Health (Gilbert, AZ)
- …expansion efforts, we are adding a new five-story tower to our Banner Gateway Medical center that will bring 109 new patient beds upon initial opening, with ... the American Society of Bariatric Surgery and the Surgical Review Corporation. Our surgeons have all completed fellowships in...shift** opportunities available. If you are a New Graduate Nurse with less than 12 months of experience, please… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …education sessions, conferences and workshops. Provides advice and support to the medical center staff, directs the development and maintenance of programs designed ... knowledge of current concepts and principles of process improvement and external review standards. Analyzes and interprets data to determine the effectiveness of the… more
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