- Molina Healthcare (Madison, WI)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring ... nursing experience, including at least 1 year of utilization review , medical claims review , long-term...or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must… more
- Fresenius Medical Center (Madison, WI)
- …Case Manager for patients with various shifts and work hours **PURPOSE AND SCOPE:** The registered professional nurse (CAP RN 1) position is an entry level ... designation into the Clinical Advancement Program for Registered Nurses. The CAP RN 1 is...years. + Minimum of 9 months experience as a Registered Nurse (preferred). + Chronic Home dialysis… more
- Fresenius Medical Center (Fitchburg, WI)
- …communicated to and implemented by the facility staff. + Maintains integrity of medical records and other FMS administrative and operational records. + Complies with ... as pertinent. **STAFF:** + Responsible for implementation of FMS staffing, and medical supply models, to provide quality patient care, and makes recommendations. +… more
- Molina Healthcare (Madison, WI)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Madison, WI)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **_Wisconsin RN license required_** JOB DESCRIPTION Job SummaryProvides support...JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are… more
- Molina Healthcare (Madison, WI)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Fresenius Medical Center (Fitchburg, WI)
- **PURPOSE AND SCOPE:** Functions as part of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a Staff ... Registered Nurse , to ensure provision of quality patient care on a daily basis in accordance with FMS policies, procedures, and training. Supports the FMCNA's… more
- Select Medical (Madison, WI)
- …**Director of Case Management** $10,000 Sign On Bonus **_Clinical license as a registered nurse or respiratory therapist or master's in social work and ... minimum three (3) years of medical case management or similar experience._** **Previous case mangement...of the department, including, but not limited to: Utilization Review (UR) and resource management, discharge planning, treatment plan… more
- Humana (Madison, WI)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and… more
- Gentiva (Madison, WI)
- …Medicare, Medicaid, JCAHO, ACHC **About You** **Qualifications - What You'll Bring:** + Current Registered Nurse ( RN ) license in the state of employment + ... Hospice Care.** We are seeking a Senior Patient Care RN Manager to join our hospice team. Reporting directly...+ Coordinate and facilitate Interdisciplinary Group (IDG) meetings to review patient care plans and update clinical documentation +… more
- Evolent (Madison, WI)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... are performed within the ** RN /LVN/LPN** scope of practice, under the Medical ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate,… more
- Veterans Affairs, Veterans Health Administration (Madison, WI)
- …patient information. Completed work should need only a general review by a registered nurse ( RN ) or physician (MD/DO) for appropriateness and conformity ... Summary The Licensed Practical Nurse (LPN) Specialty/PACT position is located in the...error. Provides safe administration of medications in accordance with Medical Center's and Nursing Service policy and monitors side… more
- Veterans Affairs, Veterans Health Administration (Madison, WI)
- …patient information. Completed work should need only a general review by a registered nurse ( RN ) or physician (MD/DO) for appropriateness and conformity ... without error. Provides safe administration of medications in accordance with Medical Center's and Nursing Service policy and monitors side effects. Continues… more
- Fresenius Medical Center (Sun Prairie, WI)
- …effective dialysis therapy for assigned patients under the direct supervision of a registered nurse . Participates in the implementation and evaluation of patient ... as your own._ **Connect with your goals and change lives** **with Fresenius Medical Care North America.** Here, we make connections that empower patients, their… more
- Humana (Madison, WI)
- …each day between 6AM and 9AM in their home time zone. **Required Qualifications** + Active Registered Nurse ( RN ) license in the state they reside. + Minimum ... independent determination of the appropriate courses of action. The Nurse Auditor 2 validates and interprets medical ...clinical and coding experience to conduct a clinical validation review of the inpatient medical record to… more
- Cardinal Health (Madison, WI)
- …interactions **_Qualifications_** + 2-4 years of experience, preferred + Current, unrestricted Registered Nurse license, required + Bachelor's degree in related ... to meet the needs of an individual patient. **_Job Summary_** The Nurse , Individualized Care promotes high-quality patient care and treatment through patient… more
- Datavant (Madison, WI)
- …+ 3+ years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS ... you will play a pivotal role in elevating the impact of our medical record documentation. You will conduct daily evaluations and engage in direct communication… more
- Highmark Health (Madison, WI)
- …State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). + Delaware RN license must be obtained within ... **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria… more
- Humana (Madison, WI)
- …guidance where needed. Follows established guidelines/procedures. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals...TRICARE, all HGB policies and procedures as well as medical necessity review criteria and privacy requirements… more
- Fresenius Medical Center (Sun Prairie, WI)
- …Report any significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine ... policy. Report any change or unusual findings to the registered nurse or supervisor. + Perform and...+ Monitors patients performing self-care under the supervision of RN . Assists patients in performing self-care as applicable **Staff… more