- Evolent (Pierre, SD)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Clinical Reviewer , Nurse , you will be a key member of the utilization management team. ... providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will routinely interact with...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Evolent (Annapolis, MD)
- …Join a mission with a company behind it. **What You'll Be Doing:** As a Clinical Reviewer , Nurse , you will be a key member of the utilization management team. We ... providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will routinely interact with...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Zelis (St. Petersburg, FL)
- …maintain bill review content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies, CCR Review Guidelines and Templates, ... of facility and provider disputes as they relate to DRG validation, itemized bill review , and/or clinical claim review Expert Claim Review . They will… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- SSM Health (MO)
- …risk adjustment (mortality) findings. + Maintains knowledge of Centers for Medicare and Medicaid Services (CMS) requirements related to clinical documentation and ... to clinical staff regarding these requirements during the concurrent record review process. + Maintains knowledge of mortality models, observed rate/expected rate… more
- Providence (OR)
- …them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care coordination, case management and ... are terminal and nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing day to day… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team....new staff to Federal laws and regulations pertaining to Medicare and Medi-Cal reimbursement. + Analyzes cases for referral… more
- Houston Methodist (Houston, TX)
- …This position has achieved an expert level at all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist Nurse job roles ... At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is...and application of positive language principles + Knowledge of Medicare , Medicaid, and Managed Care requirements + Knowledge of… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -...experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare , Medicaid,… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the largest… more