- 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
- Baptist Memorial (Memphis, TN)
- … Review Advanced Facility: BMHCC Corporate Office Department: HS Cardiac Registry Category: Nurse RN Type: Non Clinical Work Type: Full Time Work ... (3) years? clinical experience in inpatient cardiovascular care setting. Clinical chart review and abstraction experience. Special Skills Preferred: Data… 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
- HCA Healthcare (Sun City Center, FL)
- …and more affordable to gain certifications and job skills. Apply today for our Clinical Review RN Coordinator Quality Management opening and continue to ... their positions. We are seeking an experienced and professional Registered Nurse to become our Coordinator of...to you, we encourage you to apply for our Clinical Review RN Coordinator Quality… 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
- CareFirst (Cumberland, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider ... technology. + Must possess excellent verbal and written communication skills. **Licenses/Certifications** : RN - Registered Nurse - State Licensure And/or… 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
- Trinity Health (Livonia, MI)
- …within 6 months of hire. HCS-O is helpful. Remote position. ** Clinical Quality Review Specialist Position Summary - REMOTE** ** RN Must be certified in HCS-D ... off + Mileage reimbursement + Comprehensive orientation **Minimum Qualifications** Licensure: + ** Registered Nurse ** with current license from the state of… more
- Hackensack Meridian Health (Little Falls, 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
- 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
- Prime Healthcare (Ontario, CA)
- …Doctor or Graduate of an accredited school of nursing and currently licensed as a Registered Nurse required. 3. Minimum of 10 years of experience in healthcare. ... seeking new members to join our corporate team! Responsibilities VP Utilization Review and Clinical Denials Management will provide strategic leadership,… 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, ... flexibility. **Location: Position is 100% remote. Candidate must have CA RN Licensure.** **Position Purpose:** Analyzes all prior authorization requests to determine… more
- Fresenius Medical Center (Alvin, TX)
- …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 (Reno, NV)
- …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, ... with experience (2) with an active compact LPN or RN licensure and willingness to obtain other licensure as...care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Medical Mutual of Ohio (OH)
- …provider community, explaining processes for accessing health plan to perform clinical review , identifying appropriate community resources, or otherwise ... Ohio State Nursing Board. Bachelor's degree preferred + 3 years' experience as a Registered Nurse in acute care, critical care, emergency medical or medical… more
- Actalent (Atlanta, GA)
- …to providers to request additional details if applicable. Qualifications: + Active RN License + Prior Utilization management/Concurrent review experience + ... Actalent is currently hiring for Remote Utilization Review RNs! Job Description: + Reviewing authorization requests + Utilizing evidence-based criteria and making a… more