- CVS Health (Columbus, OH)
- …lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and… more
- CVS Health (Columbus, OH)
- …5+ years of clinical practice experience in medical healthcare. + 3+ years Medical Review or Utilization Management experience. + 2+ years of experience with ... Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care… more
- Molina Healthcare (Warren, MI)
- …set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... responsible for review of documentation to ensure medical necessity...state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Molina Healthcare (Long Beach, CA)
- …Licensed Vocational Nurse (LVN) license in good standing. **Preferred Education** Registered Nurse . Bachelor's Degree in Nursing or Health Related Field ... Experience** Minimum three years clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License,… more
- Emanate Health (Covina, CA)
- …and the #19 ranked company in the country. **J** **ob Summary** The Manager, Medical Necessity Review & Appeals is responsible for overseeing the evaluation of ... medical necessity, appropriateness, and cost-effectiveness of healthcare services, as...clinical experience and/or two years in Case Management, Utilization Review , payer appeals or related programs required. Experience with… more
- Penn State Health (Reading, PA)
- …and family medical or genetic information._ **Position** RN Registered Nurse Patient Safety/Peer Review /Mortality - Quality Services **Location** ... of processes to improve reliability of systems. Accountable for medical staff peer review coordination to support...experience required + Currently licensed to practice as a registered nurse by state of employment or… more
- Beth Israel Lahey Health (Boston, MA)
- …other related duties as required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts + Three years of recent ... Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate...Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical… more
- Vighter Medical Group (Killeen, TX)
- Flight Registered Nurse ( RN ), Killeen, TX...detainees being repatriated to their countries of origin. The RN will review medical records to ... - Waco, TX Position Type Full Time Education Level Registered Nurse ( RN ) Travel Percentage...Customs Enforcement. Healthcare is delivered in accordance with approved medical protocols and in compliance with Department of Homeland… more
- Trinity Health (Columbus, OH)
- …in Nursing preferred. + **License / Certification** : Current license to practice as Registered Nurse in the State of Ohio. + **Experience:** Minimum of five ... policies. + Attends Joint Commission or other regulatory meetings related to medical staff review of OPPE. + Maintains confidentiality of all peer review … more
- Independent Health (Buffalo, NY)
- …collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review to determine the medical necessity of requested services. The URN ... Degree in Nursing required; Bachelor's degree preferred. Current, active, unrestricted, and licensed registered nurse ( RN ) required. + Two (2) years of… more