- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …retrospective claim review, special review requests, and UM pre\-certifications and appeals , utilizing medical appropriateness criteria, clinical judgement, and ... **Join our team as a Clinical Review Manager\!** We are seeking a quick...for other internal positions\. **Job Qualifications** _License_ + Registered Nurse \(RN\) with active license in the state of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the use of medical and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks essential to the efficient ... expert and occasionally works directly with the operation and clinical staff to resolve issues and escalated problems. +...not limited to UM and CM, Fair Hearings and Appeals /Grievances, within three months of working in position. +… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … Clinical Services (CS) functions (prior authorization, concurrent review, appeals , case management, disease management, population health) per defined Client ... health plan administrator is looking for a full-time dynamic clinical leader who will provide leadership, oversight and accountability...Management and Population Health divisions. The position can be remote , or on-site our New York or New Jersey.… more
- State of Colorado (Pueblo, CO)
- …Position: This position works under the supervision and direction of a registered nurse and assists with psychiatric and medical nursing care of mentally ill ... of all the above. Duties in this position include: Clinical Skills: + Under the supervision of a registered... Skills: + Under the supervision of a registered nurse , interact with patients to build and sustain a… more
- State of Colorado (Pueblo, CO)
- …deliver nursing care and therapeutic interventions under the supervision of a registered nurse . The Client Care Aide II provides nursing care as assigned (ie ... Ports, or in lower-security community reintegration settings. Duties include: Clinical Skills + Is responsible to administer nursing care,...at the unit level as directed by the Lead Nurse . + Attends weekly nursing rounds or read/review and… more
- State of Colorado (Pueblo, CO)
- …to deliver nursing care and therapeutic interventions under the supervision of a registered nurse . The Client Care Aide I (CCA I) provides nursing care, which often ... in lower-security community reintegration settings. Duties in this position include: Clinical Skills: + Responsible for administering nursing care, both psychiatric… more
- State of Colorado (Pueblo, CO)
- …including physical, psychiatric, and dental maintenance. Primary Job Duties Clinical Management.Ensuring that health screens, health appraisals, histories and ... by formulating and implementing corrective action plans as needed. Supervises clinical staff to ensure compliance with established treatment protocols. Communication… more
- State of Colorado (Pueblo, CO)
- …medications and treatments; documents refusals of medications and reports this to the clinical team; and all information relevant to all aspects of the clients' ... pain or other medical needs to the Provider or Nurse + Knowing the 10 rights of Medication Administration,...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Shield of Minnesota Position Title: Care Advocacy Case Manager RN Location: Remote Career Area: Health Services About Blue Cross and Blue Shield of Minnesota ... needs across the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and… more
- Centene Corporation (Jefferson City, MO)
- …fresh perspective on workplace flexibility. **Position Purpose:** Responsible for leading clinical coding compliance nurses and non- clinical team members through ... + Identifies and implements best practices and operational efficiencies + Researches clinical and coding questions and issues + Triages and resolves escalated health… more