- Molina Healthcare (Roswell, NM)
- **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
- Ansible Government Solutions (Albuquerque, NM)
- Overview Ansible Government Solutions, LLC (Ansible) is seeking a Registered Nurse ( RN ) with required experience in Occupational and/or Travel Health ... 1515 Eubank Blvd SE, Albuquerque, NM 87123. The selected RN shall execute prompt, efficient, and confidential patient care...education classes offered internally + Assist with immunizations and medical review off Sandia employees who will… more
- Health Advocates Network (Albuquerque, NM)
- …Candidate must live 70+ miles from facility to qualify for this opening** The Registered Nurse ( RN ) plans and provides comprehensive nursing care including, ... medical records. *Assist Health Service Administrator with the review of medical files to determine all provided services are documented. *Closely monitor… more
- Health Advocates Network (Estancia, NM)
- **Must live 70+ miles from the facility for this opening** Job Summary: The Registered Nurse ( RN ) plans and provides comprehensive nursing care including, ... medical records. -Assist Health Service Administrator with the review of medical files to determine all provided services are documented. -Closely monitor… more
- Fresenius Medical Center (Albuquerque, NM)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in...+ Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. +… more
- Fresenius Medical Center (Farmington, NM)
- …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 (NM)
- 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 (NM)
- …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
- Molina Healthcare (Roswell, NM)
- …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
- Evolent (Santa Fe, NM)
- …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
- Fresenius Medical Center (Albuquerque, NM)
- **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
- Humana (Santa Fe, NM)
- …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
- Children's Home Healthcare (Albuquerque, NM)
- * RN LICENSE REQUIRED, DO NOT APPLY IF YOU DO NOT HAVE A...+ Current CPR + At least 2 years experience as a Registered Nurse + At least 1 year experience as ... VALID RN LICENSE* Children's Home Healthcare is now hiring for...Health services from insurance company. 7. Attend quarterly Utilization Review meetings as designated by the Director of Professional… more
- Community Health Systems (Carlsbad, NM)
- …Commitment to patient-centered care and continuous quality improvement. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... 3-5 years of experience in care management or utilization review required + 1-3 years of leadership experience in...+ 401(k) match + Paid Time Off (PTO) + Medical , dental, vision and flexible spending accounts + Life… more
- Humana (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …+ 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 (Santa Fe, NM)
- …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
- Molina Healthcare (NM)
- …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse (LVN)… more
- Fresenius Medical Center (Las Cruces, NM)
- …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 . **Staff Related** + Assists in training of applicable… more