- AmeriHealth Caritas (Philadelphia, PA)
- **Clinical Care Reviewer , Pediatric Shift Care, Registered Nurse ** Location: Philadelphia, PA Primary Job Function: Medical Management ID**: 34518 **Job Brief** ... **Responsibilities:** Under the direction of the unit Supervisor, the Clinical Care Reviewer - Shift Care is responsible for managing requests for pediatric shift… more
- HCA Healthcare (Corpus Christi, TX)
- …path, we encourage you to apply for our Registered Nurse Clinical Reviewer PRN opening. We review all applications. Qualified candidates will be contacted ... **Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer PRN you want in...Center Bay Area!** **Job Summary and Qualifications** **The Quality Review Nurse position encompasses multiple responsibilities including… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …Health and Workers' Compensation and other Casualty clients. The Workers' Compensation Nurse Case Reviewer collaborates with medical care providers, employers, ... and the evaluation of coverage under the Plan. The Nurse Case Reviewer reports to the Casualty...services for timely return to work. + Provides utilization review , continued stay reviews, and utilization management based on… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... required to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer RN II, under the purview the Utilization Management (UM)… more
- Kepro (ND)
- …Reviewer to join our growing team. Job Summary: Our Nurse Clinical Reviewer will use clinical expertise for the review of medical records against ... Nurse (RN) Clinical ...relationships and team building in order to facilitate the review process. Responsible for attending training and scheduled meetings and… more
- Trinity Health (Livonia, MI)
- …Type:** Part time **Shift:** Rotating Shift **Description:** **JOB SUMMARY** The Clinical Nurse Reviewer 's chief responsibility is to collect and submit reliable ... of all eligible cases for the hospital. The Clinical Nurse Reviewer also works closely with the...Word, Excel, PowerPoint) and web-based applications. + Clinical chart review and abstraction experience required + Database data entry… more
- Elevance Health (Denver, CO)
- ** Nurse Reviewer I** **Location:** Within 50 miles of a pulse point **Shift** : Monday - Friday from 9:30 am - 6:00 pm CST or PST The ** Nurse Reviewer ... on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners with… more
- Zelis (Morristown, NJ)
- Position Overview: The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical ... billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical… more
- Lee County Board of County Commissioners (Fort Myers, FL)
- Plan Reviewer Print (https://www.governmentjobs.com/careers/leecounty/jobs/newprint/4393761) Apply Plan Reviewer Salary $50,185.72 - $102,274.64 Annually ... + Questions Description JOIN OUR TEAM AS A PLAN REVIEWER ! *SALARY IS BASED ON POSSESSION OF CERTIFICATION AREA(S).... attends meetings, as required, and conducts preliminary plan review meetings with architects, engineers, developers and owners to… more
- Point32Health (MA)
- …we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Reviewer is a licensed Registered Nurse that is expected to ... a clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical necessity and, therefore,… more
- Atlantic Health System (Morristown, NJ)
- + Provides timely review of Start of Care, Resumption of Care and Recertifications. Utilizes CRC tool to provide clinical feedback related to OASIS accuracy. + ... and secondary reasons for home care based on Chart review . Advances 485 timely. + Provides timely feedback and...certified agency 3. Current state licensure as a Registered Nurse and BLS certification required. Preferred: 1. OASIS and… more
- HCA Healthcare (Corpus Christi, TX)
- …next step in your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. We review all applications. Qualified candidates ... Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your...including Core Measure chart abstraction, Stroke & STEMI chart review and coordination; performs concurrent chart reviews & is… more
- The Hartford (Alpharetta, GA)
- Medical Reviewer - CT08BE We're determined to make a...This position will also be cross trained in Drug Review . Qualifications: + RN / Nurse with ... future. The Clinical team is seeking an Initial Clinical Reviewer . This is a 100% in office position (Hartford,...(Hartford, CT or Alpharetta, GA) that will perform Utilization Review for Work ers' Compensation Claims. An Initial Clinical… more
- HCA Healthcare (Brownsville, TX)
- …important to you, we encourage you to apply for our Sepsis Coordinator Registered Nurse opening. Our team will promptly review your application. Highly qualified ... their positions. Join our Team as a(an) RN Clinical Reviewer and access programs to assist with every stage...+ Bachelor's Degree in Nursing required. + Current Registered Nurse License in the State of Texas or Multi-State… more
- HCA Healthcare (Houston, TX)
- …apart from any other healthcare provider. We are seeking a(an) RN Clinical Reviewer to join our healthcare family. **Benefits** Texas Orthopedic Hospital, offers a ... nurses play a vital part. We know that every nurse 's path and purpose is unique. HCA Healthcare is...passion for patient care. Apply today for our Clinical Reviewer opportunity! **Job Summary and Qualifications** We are seeking… more
- HCA Healthcare (Houston, TX)
- …where diversity and inclusion thrive? Submit your application for our RN Clinical Reviewer opening with HCA Houston Healthcare Northwest today and find out what it ... vary by location._ We are seeking a(an) RN Clinical Reviewer for our team to ensure that we continue...+ Bachelor's Degree in Nursing required. + Current Registered Nurse License in the State of Texas or Multi-State… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063,...to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to… more
- ManpowerGroup (Columbia, SC)
- **Job Title: Medical Claims Reviewer ** **Pay Rate:23/Hr (REMOTE opportunity after training)** **Duration:3+ Months on W2** **Location:4101 Percival Road Columbia SC ... OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LBSW (Licensed Bachelor of Social… more
- Centers Plan for Healthy Living (Queens, NY)
- Physical Therapy Reviewer Jamaica, Queens, NY, USA Req #1050 Monday, September 9, 2024 Centers Plan for Healthy Living's goal is to create the ultimate healthcare ... and plans they need for healthy living. JOB SUMMARY: The Utilization Management nurse works within a multidisciplinary team to help identify and manage members who… more
- HCA Healthcare (Kingwood, TX)
- …step in your career path, we encourage you to apply for our Registered Nurse RN Emergency Department opening. We review all applications. Qualified candidates ... you have the career opportunities as a(an) RN Clinical Reviewer you want in your current role? We invest...as assigned. What qualification you will need: + Registered Nurse , prefer at least one year of experience +… more