- Kepro (Jackson, MS)
- …to being a vital partner for health solutions in the public sector. Acentra seeks a Nurse Clinical Reviewer to join our growing team. Job Summary: The ... purpose of this position is to utilize clinical expertise to review medical records against...review processes, functions as the initial resource to nurse reviewers regarding all review process questions… more
- Lincoln Financial Group (Jackson, MS)
- …professional experience in quality assurance or the insurance field. * Registered Nurse , Liicensed Clinical Social Worker, Licensed Counselor, Licensed Mental ... #:** 73286 **The Role at a Glance** We are excited to bring on a Clinical QA Consultant to our organization. **What you'll be doing** * Completes quality audits of… more
- Baptist Memorial (Jackson, MS)
- …14373 - RN-Head Nurse Facility: MBMC - Hospital Department: JS OR MBMC Category: Nurse RN Type: Clinical Nurse Work Type: Full Time Work Schedule: Days ... Summary The Head Nurse is responsible for overseeing patient care, staff...patient autonomy, dignity and rights. Assists manager by providing clinical leadership for nursing employees on an assigned unit… more
- Humana (Jackson, MS)
- …The Utilization Management Nurse 2/Home Health Utilization Management: + Review cases using clinical knowledge, communication skills, and independent ... and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication… more
- Baptist Memorial (Jackson, MS)
- …Manager Facility: MBMC - Hospital Department: JS Case Management Administration MBMC Category: Nurse RN Type: Clinical Work Type: Full Time Work Schedule: Days ... life situation. Performs other duties as assigned. Responsibilities + Utilization Review + Discharge planning + Readmission Reduction Participation + Payer… more
- Highmark Health (Jackson, MS)
- …Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** The Registered Nurse assesses human responses and plans, implements and evaluates nursing care ... for individuals or families for whom the nurse is responsible. The Registered Nurse is...in on-going interdisciplinary communication specific to each patient with review of patient status and plan of care. +… more
- Humana (Jackson, MS)
- …strategic intermediary between the Markets (multiple levels of leadership) and the Clinical Contracting Support Team with the Medicare Markets + Collaborate with ... Market contracting organizations to identify opportunities for clinical solution implementations; engage the correct SMEs in appropriate dialogues + Partner directly… more
- Marriott (Jackson, MS)
- …claims most likely to benefit from case management to meet jurisdictional needs. **Utilization Review ** + Provide initial clinical review in order to certify ... **Additional Information** Nurse CARE Manager **Job Number** 24111133 **Job Category**...The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels if necessary, as required… more
- Evolent Health (Jackson, MS)
- …design, implementation, and oversight of the operations. Operational activities include clinical review of prior authorization requests and support additional ... have delegated UM. + Monitor all activities related to clinical review . Develop processes where indicated with...as assigned. **Qualifications - Required and Preferred:** + Active clinical license such as Registered Nurse (RN),… more
- Fresenius Medical Center (Canton, MS)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine...activities. + Enters all treatment data into the designated clinical application in an accurate and timely manner. +… more
- Highmark Health (Jackson, MS)
- …untreated mental health, alcohol use, and opioid use. The incumbent uses clinical and motivational interviewing skills to assess both behavioral and physical health ... with resources and tools to assist in health-related decision making. Conduct clinical and psycho-social assessments telephonically or in the community that address… more
- Merck (Jackson, MS)
- …of those options on patients. + Understand the significance and use of clinical trials in multiple tumor types/therapies, both in impact on promoted products and ... (Oncology group purchasing organizations, wholesalers, and specialty pharmacies). + Review and evaluate patterns for products purchased and prescribed (outpatient… more
- Prime Therapeutics (Jackson, MS)
- …experience required Managed care experience preferred. Experience documenting in a clinical record or information system. Knowledge of local community resources and ... State - Other - Other, LPN - Licensed Practical Nurse - Care Mgmt - Care Mgmt Potential pay...may vary by 8% depending on applicant location. To review our Benefits, Incentives and Additional Compensation, visit our… more