- Ascension Health (Baltimore, MD)
- …care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and service requests within ... assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or… more
- UCLA Health (Los Angeles, CA)
- …including inspections of clinical areas, patient care practices, and administrative processes + Review medical records of services in preparation for health plan ... Description The Quality Management Nurse is responsible for conducting comprehensive facility site...and safety. In this role, you will supports all Medical Group Health Education & Disease Management Programs utilizing… more
- Centene Corporation (Phoenix, AZ)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... logs of actions and/or decisions are appropriately documented + Performs clinical review of outcomes including creating and editing denial letters with the… more
- Molina Healthcare (Idaho Falls, ID)
- …within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or … more
- Beth Israel Lahey Health (Burlington, MA)
- …in people's lives.** Under the direction of the CV Service line manager and the Medical Director of the Clinical Service, the Cardio Serv Clin Rev Nurse works ... _including but not limited to:_ 1. Collects and abstracts data from patient medical records, especially those related to cardiac care. 2. Ensures the accuracy and… more
- Actalent (San Antonio, TX)
- Urgent Hiring for "Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and protect ... complete cases. Qualifications: + 2+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and discharge… more
- Vighter Medical Group (Jacksonville, FL)
- …to DHS/ICE detainees being repatriated to their countries of origin. The RN will review medical records to determine if detainees are capable of flying and ... Flight Registered Nurse (RN), Jacksonville, FL Job Details Job Location...Customs Enforcement. Healthcare is delivered in accordance with approved medical protocols and in compliance with Department of Homeland… more
- Ventura County (Ventura, CA)
- Registered Nurse II - Medical Surgical and Detox Department (Regular & Per Diem) Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4920936) ... Apply Registered Nurse II - Medical Surgical and Detox...number of qualified applications to meet business needs. FIRST REVIEW OF APPLICATIONS: May 29, 2025 Examples Of Duties… more
- CVS Health (Annapolis, MD)
- …thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services. + Consults ... function + Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Registered Nurse - Acute/ Medical (with Med/Surg Residency option) **Cost Center:** 301351177 ... Repayment Program. To learn more about program eligibility, application process and expectations please review the Nurse Corp Loan Repayment page: Apply to the … more