- Evolent (Providence, RI)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Cardinal Health (Providence, RI)
- …both scheduled outbound calls and inbound call queue. + Meets regularly with Clinical Supervisor and/or Senior Nurse , Individualized Care to discuss feedback ... who need them-faster.** **_What Individualized Care contributes to Cardinal Health_** Clinical Operations is responsible for providing clinical specialties… more
- Oracle (Providence, RI)
- …+ 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
- Humana (Providence, RI)
- …a part of our caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record ... complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently... clinical and coding experience to conduct a clinical validation review of the inpatient medical… more
- Brown University (Providence, RI)
- Job Description: Position Purpose: The Research Nurse Practitioner (NP) will provide medical support to research studies. The primary functions of this position are ... conduct support activities related to these duties. The Research NP will review medical histories with research participants, perform a physical examination to… more
- Highmark Health (Providence, RI)
- …:** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This job performs clinical review and data abstraction of patient records to support ... compliance with nationally recognized quality initiatives and the network's clinical process improvement and patient safety initiatives. The incumbent requires… more
- US Tech Solutions (RI)
- **Job Description:** + Responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets data obtained ... company policy and other processes which are required to support the review of the clinical documentation/information. + Pro-actively and consistently applies… more
- Datavant (Providence, RI)
- …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 ... Collaborate with physicians and caregivers to ensure appropriate reimbursement and clinical severity for DRG-based payer patients. + Demonstrate understanding of… more
- Prime Healthcare (Woonsocket, RI)
- …The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive ... admission and concurrent review of the medical record for the medical necessity,...accredited school of nursing and a current state Registered Nurse license2. Grandfathered prior to April 1, 2015. Minimum… more
- Prime Healthcare (Woonsocket, RI)
- …The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive ... admission and concurrent review of the medical record for the medical necessity,...accredited school of nursing and a current state Registered Nurse license + Grandfathered prior to April 1, 2015.… more
- CenterWell (Providence, RI)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience,...three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience… more
- University Medicine (East Providence, RI)
- …lab specimens, gives injections, and performs routine medical tests. + Implements clinical and technical aspects of nursing care in accordance with prescribed ... policies, procedures, and techniques. + Assisting with review of test results under guidance of a physician and notifying patients of results when applicable. +… more
- Humana (Providence, RI)
- …our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- Fujifilm (Providence, RI)
- **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...in: + MPI + MUGA + PET + (CV)Registered Nurse Cardiac experience in: + Cath, Peripheral Angiography, Electrophysiology… more
- University Medicine (East Providence, RI)
- …Medicine's Division of General Internal Medicine and Primary Care is seeking a Clinical Psychologist with an interest in Integrated Behavioral Health to join our ... mission of Brown Medicine is high-level quality patient care, state-of-the-art clinical research, and dedicated teaching of more than 400 medical students,… more
- Prime Healthcare (Woonsocket, RI)
- …Massachusetts since 1873. Learn more at www.landmarkmedical.org. Responsibilities The Clinical Coordinator supports clinical and administrative responsibilities ... and meeting daily with the preceptor and orientee to review progress and address any learning gaps. Oversees the... progress and address any learning gaps. Oversees the clinical performance of staff, delivered on the shift. Acts… more
- Datavant (Providence, RI)
- …Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and necessity of continued stay ... recognized medical necessity criteria and standards of care, along with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed… more
- Charter Care Health Partners (North Providence, RI)
- …'s primary state of legal residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical experience that includes recent ... or designee. Provides coordinated care support to Physician leadership and Clinical Manager(s) of respective services. Makes daily rounds and collaborates with… more
- Charter Care Health Partners (North Providence, RI)
- …'s primary state of legal residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical experience that includes recent ... or designee. Provides coordinated care support to Physician leadership and Clinical Manager(s) of respective services. Makes daily rounds and collaborates with… more
- Elderwood (Wakefield, RI)
- …assessment, documentation, and service delivery. + Direct, orient, and support key clinical staff, including the ADON/Day Supervisor, Head Nurse , Evening ... This pivotal role is responsible for ensuring the delivery of high-quality clinical care, supporting and developing nursing staff, and maintaining a positive,… more