- Evolent (Dover, DE)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Fresenius Medical Center (Dover, DE)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- Highmark Health (Dover, DE)
- …facilities and providers for care-coordination. + Participate in rounds with the Medical Director. + Review documentation and processes for consistent practice, ... hospice, public health, or assisted living **Or** + Registered Nurse or Licensed Practical Nurse and 2...with developmental disabilities population + Two years in home clinical or case management experience + Medicare and Medicaid… more
- Datavant (Dover, DE)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more
- Highmark Health (Dover, DE)
- …:** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This job performs clinical review and data abstraction of patient records to support ... Preferred + Associate's or Bachelor's Degree in Nursing + 1 year performing medical record review and data abstraction for cardiovascular registries + Proficient… more
- CenterWell (Dover, DE)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience,...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Fujifilm (Dover, DE)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...HCUS team to gain customer acceptance of the FUJIFILM Medical Systems solution. + Participates in teaching and training… more
- Cardinal Health (Dover, DE)
- …to ensure a positive and satisfactory experience for all customers. The Supervisor, Clinical Operations monitors nurse to patient contact quality and provides ... manufacturers to rethink the reach and impact of their products. The Supervisor, Clinical Operations provides management and clinical oversight to a team of… more
- Oracle (Dover, DE)
- …+ Excellent communication, stakeholder engagement, and leadership skills. **Preferred Qualifications:** + Clinical experience as a nurse or physician with a deep ... **Job Description** The Clinical Note AI Agent Product Management Leader will...Gather and analyze information to define product specifications and review design specifications. Envision and communicate product strategy and… more
- Fresenius Medical Center (Milford, DE)
- …direct patient care staff on appropriate programs under the supervision of a nurse . + Provides developmental support to applicable clinical and facility staff. ... for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training...Related** + Participates in the recruitment process for new clinical staff + Assists with clinical orientation… more
- Fresenius Medical Center (Dover, DE)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine...activities. + Enters all treatment data into the designated clinical application in an accurate and timely manner. +… more
- Datavant (Dover, DE)
- …Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and necessity of continued ... necessity criteria and standards of care, along with clinical knowledge and expertise successfully. Ideal candidate should be...to author appeal letter Identification of referrals to the medical director for review + Select appropriate… more
- Humana (Dover, DE)
- …our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration...of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills,… more
- Oracle (Dover, DE)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will… more
- Merck (Dover, DE)
- **Job Description** Our Sales team support our customers by providing clinical information about products, educational information, clinical training programs ... impact of those options on the patient. Must understand impact and use of clinical trials in multiple tumor types/therapies, both in impact on promoted products and… more
- Highmark Health (Dover, DE)
- …and retrospective claims review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or… more
- CVS Health (Dover, DE)
- …+ Coordinates and arranges for health care service delivery under the direction of nurse or medical direction in the appropriate setting at the most appropriate ... Care Management Associate you will be supporting comprehensive coordination of medical services including Care Team intake, screening and supporting the… more
- Merck (Dover, DE)
- …(Oncology group purchasing organizations, wholesalers, and specialty pharmacies). + Review and evaluate patterns for products purchased and prescribed (outpatient ... the in-scope customer team: Customer Team Leader, Key Account Manager, Nurse Educator, Field Reimbursement Associate, Medicare Account Executive, and more.… more
- CVS Health (Dover, DE)
- …assessing the member's health status and care coordination needs, inpatient review , and discharge planning, developing, and implementing the case management plan, ... monitoring, and evaluating the plan and involving the Medical Director as indicated and closing the case as...discharge criteria. The Case Manager RN role requires a nurse that can exercise independent and sound judgment and… more