- Centers for Independence (Waukesha, WI)
- **Registered Nurse Clinician - CRC Waukesha** **Job Details** **Job Location** CRC Waukesha - Waukesha, WI **Position Type** Full Time **Education Level** Bachelor's ... educational and policy materials in clinical field manuals. 16. Write and review consumer incident reports and ensure proper follow-up. Ensure Director receives a… more
- Fresenius Medical Center (Sheboygan, WI)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... including efficient utilization of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and on-site state or… more
- Evolent (Madison, WI)
- …The Specialty Appeal nurses work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators who set up the ... appeal, Physicians and other Clinicians who review the appeal, and managers for direction and leadership. The Appeals teamwork strategies and opportunities for… more
- CenterWell (Madison, WI)
- …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 ... focuses on excellent service to others. **Preferred Locations:** Daytona, FL, Louisville, KY, San Antonio, TX **Use your skills to make an impact** **Role Essentials** + Active RN license + Possession of or ability to obtain Compact Nursing License + A minimum… more
- SSM Health (Fond Du Lac, WI)
- …leadership and applies clinical knowledge to ensure the medical staff peer review process is effective in evaluating issues related to professional practice. ... data trending, reports and analysis for medical staff leadership and peer review committee consistent with established guidelines. Manages the physician peer … more
- Wolters Kluwer (Madison, WI)
- …Content Specialist - Nursing, you will work closely with the PreView & ReView Manager/Senior Clinical Content Specialists to plan and deliver high quality NCLEX ... Review services by identifying and assessing client needs and...the platform for new products. + Collaborate with the nurse educator team to evaluate practices and processes in… more
- CVS Health (Madison, WI)
- …guiding the team in determining correct coding and appropriate documentation during the review of medical records. This role requires a strong focus on meeting ... projects. + Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to investigators,… more
- Centene Corporation (Madison, WI)
- …health clinicians preferred. Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required. Knowledge of ABA services ... and BH utilization review process required. Experience working with providers and healthcare...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Molina Healthcare (Racine, WI)
- …meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical ... Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. To all… more
- Ascension Health (Milwaukee, WI)
- …+ Develop systems and process for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to implement and manage ... for all clients. **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date or job transfer date required. Education:… more