- CHRISTUS Health (Wake Village, TX)
- Description Summary: The Registered Nurse Clinical Care Coordinator is responsible for evaluating, coordinating, processing, screening, and documentation of ... patient entry into the CHRISTUS Health System. The Registered Nurse Clinical Care Coordinator...CMO when discrepancies are present. * Performs the initial clinical medical necessity review utilizing evidence-based criteria… more
- CommonSpirit Health Mountain Region (Durango, CO)
- …flourish and leaders who care about your success. Assist with training and coordinating clinical review and quality assurance. Lead and review the ... clinical care and documentation practices related to patients/residents. Review and evaluate quality data to determine areas needing...documentation of the home health and/or hospice patient. + Registered Nurse + Valid CO Driver's License.… more
- Elevance Health (Miami, FL)
- ** Clinical Review Nurse I -...which would provide an equivalent background. + Current unrestricted RN license required. + **This position is part of our ... Friday 8 am - 5 pm EST or CST. Hours are flexible.** The ** Clinical Review Nurse I** is responsible for reviewing and making medical determinations as… more
- Centers Plan for Healthy Living (Margate, FL)
- Clinical Review RN 5297 W Copans Rd, Margate, FL 33063, USA Req #460 Tuesday, November 5, 2024 Centers Plan for Healthy Living's goal is to create the ... plans they need for healthy living. Job Summary: We are currently looking for Clinical Review RN 's to join our team. These positions are responsible for the… more
- Elevance Health (Indianapolis, IN)
- ** Clinical Review Nurse Sr.**...which would provide an equivalent background. + Current unrestricted RN license required. + **This position is part of ... **Hours: Monday through Friday 8 am - 4:30 EST. Hours are flexible.** The ** Clinical Review Nurse Sr** . is responsible for coordinating and overseeing the… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review Clinical Review (CR) 3 Team Lead will assist the Director of UR and Associate Director of UR with daily staff mentoring, ... and provide input for committees. Other duties as assigned. Minimum Qualifications: NYS Licensed/ Registered (or eligible) RN , Bachelors Degree in Nursing and a… more
- St. Luke's Health System (Boise, ID)
- **Overview** At St. Luke's, our dedicated team of Clinical Review Nurses strive to build a positive, supportive, and inclusive culture that delivers exceptional ... overview to job seekers. **Default: Location : City** _Boise_ **Category** _Nursing - RN and Leadership_ **Work Unit** _Clinical Review Management System Office_… more
- Prime Therapeutics (Columbus, OH)
- …position has managerial and clinical oversight of the Clinical Pharmacist and Registered Nurse Review Team, playing a key role in medical and ... drives every decision we make. **Job Posting Title** Supervisor Clinical Pharmacist Review - Remote in California...+ Drives the daily performance of a team of Clinical Pharmacist and Registered Nurse … more
- Trinity Health (Livonia, MI)
- …required within 6 months of hire **Trinity Health at Home is seeking an experienced RN Clinical Quality Review Specialist for a remote position** **ICD10 ... **Description:** Trinity Health at Home is seeking an experienced RN remote Clinical Quality Review ...and top clinical outcomes. **Minimum Qualifications** + ** Registered Nurse with current license from the… more
- Penn Medicine (Bala Cynwyd, PA)
- …our future each day. Are you living your life's work? Summary: + The Clinical Documentation Review Specialist is responsible for collaborating with clinicians to ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …single largest account Position Summary: The RN Clinical Provider Post Service Review Manager , led by a Registered Nurse , is responsible for a ... a member and provider call center, provider correspondence and appeals, clinical review , member correspondence and reconsiderations, enrollment, claims… more
- Hackensack Meridian Health (Brick, NJ)
- …+ Home Care Experience Licenses and Certifications Required: + NJ State Professional Registered Nurse License. + Certificate for Oasis Specialist (COS-C, COQS, ... appropriate documentation for coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review ...issues to the Director of the certified operation, Hospice Clinical Director, and the Nurse Manager for… more
- Centene Corporation (Sacramento, CA)
- …on workplace flexibility. This is a fully remote that requires California RN Licensure. **Position Purpose:** Performs clinical reviews needed to resolve ... changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- Fresenius Medical Center (Columbus, OH)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Centene Corporation (Sacramento, CA)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... on workplace flexibility. **Fully Remote position that requires a CA RN Licensure.** **Position Purpose** : Performs concurrent reviews, including determining… more
- Centene Corporation (Austin, TX)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- SUNY Upstate Medical University (Syracuse, NY)
- …complaints that require quality review and/or Risk oversight. Minimum Qualifications: Registered Nurse , NYS License and Bachelors Degree in Nursing or ... Job Summary: High-level clinical review of patients admitted to the University Hospital for the purpose of risk identification and referral to clinical … more
- Centers Plan for Healthy Living (Margate, FL)
- …federal regulatory requirements including timelines. + Presents recommendations based on clinical review , criteria, and organizational policies + Communicates ... RN - Grievance and Appeals Clinical ... RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL...in writing. + Analyze and complete written summaries on clinical cases. EDUCATION AND EXPERIENCE: Education: RN … more
- Penn Medicine (Philadelphia, PA)
- …develop/upkeep efficiencies/synergies within the Clinical Documentation department + Enter clinical review data and related anticipated follow-up in the CDI ... + RHIA, RHIT and CCS certifications (Preferred) + CCDS or CDIP (Preferred) + Registered Nurse (Preferred) Education or Equivalent Experience: + Bachelor of Arts… more
- UCHealth (Aurora, CO)
- …Bachelor's degree relevant clinical field. + State licensure as Registered Nurse , Occupational Therapist, Physical Therapist, Speech Language Pathologist, ... and meeting structure * Reviews and triages cases for clinical review * Promotes use of Just...in a fast-paced environment and take appropriate action. Requirements:* Registered Nurse * Occupational Therapist - State… more
