- Molina Healthcare (Rio Rancho, NM)
- …2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... for denial or modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider… more
- System One (Baltimore, MD)
- …travel to providers for record retrieval, as needed. Clinical Medical Review Nurse / Medical Records Abstraction Specialist Schedule: 8-hour shifts (start ... Job Title: Clinical Medical Review Nurse Location: Baltimore,...care preferred) + Previous case management, discharge planning, or utilization review experience + EMR navigation experience… more
- Evolent (Phoenix, AZ)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Mohawk Valley Health System (Utica, NY)
- …and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, ... regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay,… more
- Bassett Healthcare (Oneonta, NY)
- …controlling, climate setting, leadership, and operational duties. The Respiratory Care Specialist will provide clinical training regarding respiratory care to ... active participation in staff development and training. Measured by signature of clinical proficiencies and leadership review + Facilitates development and… more
- New York State Civil Service (Newburgh, NY)
- …experimental psychology, research psychology, industrial psychology, organizational psychology, utilization review , guidance counseling, etc.Psychologist 2:You ... psychology, research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance counseling, pastoral counseling, or… more
- Stanford Health Care (Palo Alto, CA)
- …APPs. The Lead APP also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or ... and adherence to policy through practice analysis and case review of APPs with physicians. . Investigate and respond...APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse… more
- CenterWell (Columbia, SC)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities in ... patient management (HRPM), and social determinants of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily… more
- CenterWell (Phoenix, AZ)
- …medical guidance and expertise. + Develop, implement and monitor the outcomes of utilization review and disease management programs to meet the quality and ... + Oversee daily operations of physician services. + Build strong relationship with specialist , hospitalist, SNF and other providers to form a narrow network of… more
- Stanford Health Care (Redwood City, CA)
- …of their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), or ... as a licensed advanced practice provider: (Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or Certified Registered Nurse Anesthetist). +… more