- Centene Corporation (Sacramento, CA)
- …administered with quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against ... Remote Role, California RN Licensing Highly Preferred **Position Purpose:** Performs a clinical retrospective review of services previously provided to determine… more
- Actalent (Tigard, OR)
- Job Title: Clinical Review Nurse - Concurrent Review Work Environment + This is a 100% remote position + The schedule is Tuesday to Saturday, 10 AM to 7 PM ... preferred. + Understanding of utilization management processes preferred. + Proficient in clinical review , case management, and concurrent review . Job… more
- Centene Corporation (Sacramento, CA)
- …with interdepartmental teams on projects within utilization management as part of the clinical review team + Partners and works with Medical Affairs and/or ... 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,… more
- Children's Mercy Kansas City (Kansas City, MO)
- …improve the lives of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based ... from admission through hospital stay to discharge. Adeptly uses evidence based clinical practice guidelines to determine the appropriate level of care and the… more
- St. Luke's Health System (Meridian, 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 ... City** _Boise_ **Category** _Nursing - Experienced_ **Work Unit** _Clinical Review Management System Office_ **Position Type** _Full-Time_ **Work Schedule**… more
- Hackensack Meridian Health (Edison, NJ)
- …transform healthcare and serve as a leader of positive change. The **Sleep Clinical Review Technician** is responsible for clinical history, signs/symptoms, ... diagnosis code and test order review . Works directly with team members and ordering clinicians and their staff to educate and support appropriate documentation for coding, authorizations and appropriate testing. This position will offer a hybrid schedule.… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- LifePoint Health (Henderson, NC)
- …awards programs . And much more *Position Summary* Conducts chart audits/reviews for clinical practice guidelines, death review , blood review , core measures ... of CMS, TJC when performing chart abstractions for these entities. Performs clinical concurrent review , conducts team meetings, and coordinates internal… more
- HCA Healthcare (Brentwood, TN)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Denials Coding Review Specialist with Parallon you can be a ... to succeed in our organization. We are looking for an enthusiastic Clinical Denials Coding Review Specialist to help us reach our goals. Unlock your potential!… more
- BAYADA Home Health Care (Austin, TX)
- …company match, direct deposit, and employee assistance program **Responsibilities:** + Review clinical information for appropriateness, congruency, and accuracy ... immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work...for this role (Please note, while this is a clinical opening, BAYADA does have non- clinical openings… more