- Hartford HealthCare (Hartford, CT)
- …different specialties. The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely ... data registry activities, including program teleconferences and meetings. Maintains Surgical Clinical Reviewer (SCR) certification on an annual basis, in… more
- AmeriHealth Caritas (Washington, DC)
- …determinations based on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the appropriateness of services, identifies care ... cases are escalated to the Medical Director for further review . The reviewer independently applies medical and...(BSN) preferred + Minimum of 3 years of diverse clinical experience as a Registered Nurse in… more
- University of Michigan (Ann Arbor, MI)
- …Survival Flight Initial Training Curriculum is to prepare the proficient emergency / critical care nurse for clinical practice as a Survival Flight Nurse at ... REGISTERED NURSE / FLIGHT NURSE SPECIALIST : University...Care, High Risk Obstetrics and Introductory Radiology and Diagnostics. Clinical education will also include Survival Flight Third-rider experience,… more
- Magellan Health Services (Baton Rouge, LA)
- …other clinical staff. + Provides training, interpretation and support for QI Clinical Reviewer staff. + Audits and validates internal audit results and/or ... according to medical necessity criteria. General Job Information Title Clinical Reviewer III, Licensed/Remote (Louisiana) Grade 26... Counselor - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care MgmtCare… more
- UCLA Health (Los Angeles, CA)
- … documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role...benefit coverage. + Applies UCLA Health protocols and national clinical guidelines (eg, InterQual, Milliman) in review … more
- Centers Plan for Healthy Living (Margate, FL)
- …for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify and ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- ChenMed (Norfolk, VA)
- …This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere ... nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization, provide family education and identify… more
- UTMB Health (League City, TX)
- … clinical specialization. + Current Texas Advanced Practice Registered Nurse licensure. No experience required. **Job Description:** Provides advanced practice ... all services are accurately accounted for and available for review by the interdisciplinary team. + Adheres to internal...Advanced Practice Registered Nurse (APRN) in a nurse practitioner clinical area of specialization by… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... a case for determination, interacting directly with providers to obtain additional clinical information, and with members or their advocates to understand the full… more
- MD Anderson Cancer Center (Houston, TX)
- …5 years Experience in clinical nursing and 1 year Experience in utilization review . * May substitute preferred degree for two years of the five clinical ... As a * Nurse Defense Auditor* in our *Hospital Billing &...supports patient access to life-saving care. This role combines clinical knowledge, insurance expertise, and critical thinking to resolve… more