- NHS Management, LLC (Fayetteville, AR)
- …risk management policies to include reviews of significant events/unusual occurrences and a review of the medical record. We offer the following benefits for ... way. We are in search of a qualified Regional Nurse Consultant: The Regional Nurse Consultant will...that need improvements or change. 3. Eliminate/reduce resident liability claims through use of corporate policies and established customer… more
- Geisinger (Wilkes-Barre, PA)
- …As one of the Top 8 Most Innovative Healthcare Systems in Becker's Hospital Review , we're working to create a national model for improving health. Today, we're ... clinical risk management as part of the System's Peer Review process. Performs all duties in a manner that...support for patients. At least 5 years of Registered Nurse work experience is required. BSN is required. The… more
- Travelers Insurance Company (New York, NY)
- …Utilize evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim… more
- BronxCare Health System (Bronx, NY)
- …(according to the NPSG), intake screening of patient, pre-visit planning (if applicable), review of medical record to determine visit requirements such as HEIDS ... Overview Licensed Practical Nurse : Under the direct supervision of a physician...analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more
- US Tech Solutions (Columbia, SC)
- …available resources to promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate ... first 1-2 weeks remote position after training. + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying… more
- CVS Health (Haddonfield, NJ)
- …and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. The ... to enhance a member's overall wellness. + Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. + Applies clinical… more
- Abbott (Temecula, CA)
- …spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 114,000 colleagues ... you dream of. + Employees can qualify for free medical coverage in our Health Investment Plan (HIP) PPO..., currently has an opportunity for a **Occupational Health Nurse .** **What You'll Work On** Provides for and delivers… more
- Elevance Health (Norfolk, VA)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope… more
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager I** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager I** is responsible for telephonic care...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisor's on the development of… more
- Sutter Health (Sacramento, CA)
- …quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and ... experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and… more