- Centene Corporation (New York, NY)
- …license.** **Inpatient Utilization Management** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical ... between utilization management team, members, and providers + Monitors prior authorization, concurrent review , and/or retrospective clinical review nurses… more
- AdventHealth (Orlando, FL)
- …we are even better. **Schedule:** Full Time **Shift** : Days **Location: Remote ** **The role you'll contribute:** The Clinical Documentation Integrity Manager is a ... Registered Nurse and/or a Registered Health Information Administrator with a...and clinical documentation specialists. This role will oversee the review processes of complex patients that vary in age… more
- University of Michigan (Ann Arbor, MI)
- …and care of their children. The Pediatric Cardiothoracic Intensive Care Unit nurse cares for patients in a technology-intensive environment, including ECMO, CRRT, ... in Nursing staff development programs and workshops. + Participate in a concurrent and retrospective evaluation of patient care consistent with the hospital quality… more
- AmeriHealth Caritas (Washington, DC)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines to ... or denial decisions + Identify and escalate complex cases requiring physician review or additional intervention + Ensure compliance with Medicaid industry standards… more
- BrightSpring Health Services (Gainesville, FL)
- …of Nursing is unavailable + Participates on the safety, infection control, incident review and human rights committees + Facilitates communication and serves as a ... education coursework to facilitate licensure as a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN)...governing sources + Excellent communication with ability to handle concurrent tasks and responsibilities + Ability to work as… more
- GE Vernova (Wilmington, NC)
- …oversight of suppliers thru procurement and construction to develop, perform, and review unit, module, system, and integration test plans, procedures, and reports ... Engineer-Procure-Construct (EPC) partner(s), and suppliers. + Perform detailed oversight, review , and verification of deliverables from suppliers to ensure their;… more
- Oracle (Harrisburg, PA)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... directly with clients at a prominent academic medical center in the Midwest. This remote role will act as the primary subject matter expert and point person for… more
- GE Vernova (Wilmington, NC)
- …regulatory certification or licensing document preparation, + Perform technical oversight, review , and verification of deliverables from suppliers to ensure their ... Vernova Nuclear Energy Headquarters in Wilmington, NC; but highly qualified (US based) remote candidates will be considered. + This role requires access to US… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …monitoring, oversees all Clinical Services (CS) functions (prior authorization, concurrent review , appeals, case management, disease management, population ... Management and Population Health divisions. The position can be remote , or on-site our New York or New Jersey....oversees all Workers' Compensation (WC) Case Management and Utilization Review (UR) Programs. + Collaborates with the Chief Medical… more
- Adecco US, Inc. (Minneapolis, MN)
- …applying benefits and criteria to clinical reviews . Utilization Management, pre-authorization, concurrent review , or appeals experience **Why work for Adecco?** ... Adecco Healthcare & Life Sciences is hiring remote RN Appeals Reviewers! This role is ...when appropriate. . You will summarize medical information for review by the Medical Director as needed, ensuring a… more