- Evolent (Jefferson City, MO)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as... medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all… more
- Veterans Affairs, Veterans Health Administration (Columbia, MO)
- …and record relevant patient information. Completed work [should need] only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... patient information. Completed work should need only a general review by a registered nurse (RN) or...nursing skills and interventions 2) Ability to quickly identify medical urgencies and emergencies 3) Clinical problem-solving… more
- Veterans Affairs, Veterans Health Administration (Columbia, MO)
- …preceptor providing didactic and clinical instruction in anesthesia to student nurse anesthetists, medical and dental residents, and other health care ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Veterans Affairs, Veterans Health Administration (Jefferson City, MO)
- …care/outpatient clinic experience. Prefer 2-3 years of outpatient experience. Strong medical clinical background. Reference: For more information on this ... solving with core team (Patient, Primary Care Provider, Registered Nurse , and Medical Support Assistant) and expanded...and outcomes. Completed work [should need] only a general review by a registered nurse (RN) or… more
- CenterWell (Jefferson City, MO)
- …complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to ... to work every other holiday.** The **Care Manager, Telephonic Nurse ** helps to ensure optimal continuity of care for...Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services +… more
- Veterans Affairs, Veterans Health Administration (Columbia, MO)
- …and medical needs by obtaining and reviewing all pertinent clinical information from the community provider. The LPN/LVN will collaborate in interdisciplinary ... a hospital, outpatient clinic, nursing home, or other supervised medical , nursing, or patient care facility that provided a...patient information. Completed work should need only a general review by a registered nurse (RN) or… more
- Datavant (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …:** 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 (Jefferson City, MO)
- …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
- Oracle (Jefferson City, MO)
- …+ 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
- Zurich NA (Jefferson City, MO)
- Sr Supplier Medical Process Specialist 128416 Zurich North America is seeking am experienced Sr. Supplier Medical Process Specialist to join our team in one of ... commitment to work/life balance, and outstanding culture. As a Sr. Supplier Medical Process Specialist, you will manage supplier performance and work product in… more
- Humana (Jefferson City, MO)
- …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
- Centene Corporation (Jefferson City, MO)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... is complete for allergies, height, weight, current and past medical history, clinical laboratory results and concurrent...report and manage adverse events + Assist the physician, nurse and patient with clinical and technical… more
- Oracle (Jefferson City, MO)
- …(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
- Sedgwick (Jefferson City, MO)
- …**PRIMARY PURPOSE** **:** To manage complex high-exposure general liability claims; to review medical treatment records associated with general liability, bodily ... related clinical nursing experience to include two (2) years nurse consultant experience or equivalent combination of education and experience required.… more
- CenterWell (Jefferson City, MO)
- …are excited to offer the role of Virtual Physician Collaborator for CenterWell Medical Group, a new virtual care delivery group within CenterWell Senior Primary ... in care, ensuring timeless access to important medications and solving urgent clinical needs. This Virtual Physician Collaborator shares in our vision to innovate… more
- Highmark Health (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …enhance a member's overall wellness through integration. * Through the use of clinical tools and information/data review , conducts an evaluation of member's ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...smooth transition to Aetna programs and plans. * Applies clinical judgment to the incorporation of strategies designed to… more
- Merck (Jefferson City, MO)
- …(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