- Evolent (Montgomery, AL)
- …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
- Chenega Corporation (Maxwell AFB, AL)
- …age 18 years. + Identify and manage specific pediatric illnesses. + Prepare and review case histories and clinical records of newborns, infants, children, and ... **Summary** **C2 ALASKA, LLC** Maxwell AFB, AL The **Pediatric Nurse Practitioner** (NP) will be the Primary Care Manager (PCM) for a panel of up to 1,300 patients.… more
- Fresenius Medical Center (Montgomery, AL)
- …regulations at: https://content.intranet.fmcna.com/regulatory-affairs/wp-content/uploads/sites/46/2019/05/Pre-Licensed- Nurse -50-State- Review ... of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a...transcribes, and enters physician lab orders accurately into the Medical Information System. + Ensures appropriate preparation of lab… more
- Diversicare Healthcare Services & Diversicare Ther (Montgomery, AL)
- …precision and purpose. Your role involves maintaining accurate and comprehensive active medical records, conducting clinical record audits, and educating our ... and audits medical records for new admissions/readmissions and maintains the clinical record throughout the resident's entire stay within the center. 2. Oversees… more
- Humana (Montgomery, AL)
- …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....TRICARE, all HGB policies and procedures as well as medical necessity review criteria and privacy requirements… more
- Humana (Montgomery, AL)
- …and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis ... independent determination of the appropriate courses of action. The Nurse Auditor 2 validates and interprets medical ...coding experience to conduct a clinical validation review of the inpatient medical record to… more
- Datavant (Montgomery, AL)
- …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 (Montgomery, AL)
- …:** 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 (Montgomery, AL)
- …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
- CenterWell (Montgomery, AL)
- …policies and standards. + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by ... On-site Branch Location: Prattville, FL $10K Sign-On Bonus The ** Clinical Manager** coordinates and oversees all direct care patient...Utilization Review staff. Upon completion of the assessment, creates and… more
- Oracle (Montgomery, AL)
- …+ 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 (Tuskegee, AL)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies, procedures, and training and in compliance ... last treatment. Report any complaints or observations to the nurse supervisor. + Evaluate vascular access for patency and...activities. + Enters all treatment data into the designated clinical application accurately and in a timely manner. +… more
- Veterans Affairs, Veterans Health Administration (Tuskegee, AL)
- …initiatives Assigning, directing, and reviewing work, to include Physicians and Nurse Practitioners. Establishing performance standards and work review and ... with subordinate supervisors. Coordinating Academic/Teaching/Training opportunities with residents and/or medical students. Participation in Peer Review process.… more
- Datavant (Montgomery, AL)
- …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 (Montgomery, AL)
- …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 (Montgomery, AL)
- …(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
- Veterans Affairs, Veterans Health Administration (Tuskegee, AL)
- …so needed. The incumbent will also supervise trainees, including but not limited to medical students and residents in the appropriate clinical setting. Serves a ... related to Traumatic Brain Injuries. Establishes professional working relationships with other clinical service providers within the medical center and outlying… more
- CenterWell (Montgomery, AL)
- …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 (Montgomery, AL)
- …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 (Montgomery, AL)
- …referrals. + Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs review of member claim history to ... with contract. + Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target… more