- Evolent (Charleston, WV)
- …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
- Fresenius Medical Center (Moorefield, WV)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Cardinal Health (Charleston, WV)
- …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
- Highmark Health (Charleston, WV)
- …of Quarterly State Audit Reviews, Annual MERCER Review and NCQA Review . Develops ongoing educational programs that ensures clinical and non- clinical ... - 7 years in Social Work **LICENSES OR CERTIFICATIONS** **Required** + Registered Nurse or + Licensed Clinical Social Worker (LCSW) - Non-Specific **Preferred**… more
- Oracle (Charleston, WV)
- …+ 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
- Veterans Affairs, Veterans Health Administration (Clarksburg, WV)
- …to the educational mission as a mentor or preceptor providing didactic and clinical instruction in anesthesia to student nurse anesthetists, medical and dental ... Summary The Certified Registered Nurse Anesthetist (CRNA) provides a full range of...of the Veteran Affairs mission. The CRNA provides advanced clinical practice, consultation and management.The CRNA administers anesthesia in… more
- Humana (Charleston, WV)
- …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
- Veterans Affairs, Veterans Health Administration (Beckley, WV)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Fully navigate patient's medical records to find relevant data to support their clinical visit. Ensure correct time out process is followed for all clinical… more
- BrightSpring Health Services (Dunbar, WV)
- …of death and submit to State Health Services Director and Assigned Director, Clinical Practice* Review utilization report at least monthly to ensure adequate ... health services for all assigned service sites. Provides oversight and direction for clinical services, and health & wellness for all clients in assigned area of… more
- Veterans Affairs, Veterans Health Administration (Huntington, WV)
- …and record relevant patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... Summary The Licensed Practical Nurse (LPN) provides care in the surgery clinic...and documents observations and care provided in the patient's clinical record. Completes and/or reinforces basic patient/family teaching, supports… more
- Highmark Health (Charleston, WV)
- …:** 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
- Datavant (Charleston, WV)
- …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 (Chester, WV)
- …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 (Charleston, WV)
- …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
- Humana (Charleston, WV)
- …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
- Select Medical (Charleston, WV)
- …Management** **Full Time: Monday - Friday 8-5pm** **_Clinical license as a registered nurse or respiratory therapist or master's in social work and minimum three (3) ... is right. As the Director of Case Management **,** you will use your clinical knowledge and contribute to the overall functions and professional growth of the… more
- Fresenius Medical Center (Fairlea, WV)
- …direct patient care staff on appropriate programs under the supervision of a nurse . + Provides developmental support to applicable clinical and facility staff. ... for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training...Related** + Participates in the recruitment process for new clinical staff + Assists with clinical orientation… more
- Fresenius Medical Center (Grafton, WV)
- …effective dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies procedures and training and in compliance ... last treatment. Report any complaints or observations to the nurse supervisor. + Evaluate vascular access for patency and...activities. + Enters all treatment data into the designated clinical application accurately and in a timely manner. +… more
- Datavant (Charleston, WV)
- …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
- CenterWell (Ona, WV)
- …from the field staff and assisting with weekly case conferences. Refers clinical questions to Branch Director as necessary. + Maintains the client hospitalization ... task appears on the action screen. Ensures staff are scheduled for skilled nurse /injection visits unless an aide supervisory visit is scheduled in conjunction with… more