- HCA Healthcare (Nashville, TN)
- …treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile ... any other healthcare provider. We are seeking a(an) Assessment Specialist PRN to join our healthcare family. **Benefits** TriStar...patients in regard to managed care organizations + Conducts utilization review for managed care cases in… more
- Penn Medicine (Lancaster, PA)
- …day. Are you living your life's work? Summary: + The Home Health Quality Specialist is responsible for collaborating with clinicians at established points in time to ... and development of effective plans of care to assure appropriate utilization and promote appropriate qualitypatient care and positive patient outcomes.… more
- Rush University Medical Center (Chicago, IL)
- …may vary depending on the circumstances of each case. **Summary:** The Clinical Consulting Specialist is a nurse with expertise within a specialized area of ... best practices, policies, strategic goals and RUSHICARE values. The Clinical Consulting Specialist role is a member of the nursing leadership team and demonstrates… more
- UPMC (Pittsburgh, PA)
- UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our Coding Department. This position will be a work-from-home position ... role requires three years of coding experience. In this role, you will review clinical documentation within the medical record to ensure that all patient resource… more
- Stanford Health Care (Palo Alto, CA)
- …professional growth and development of their APPs. Also functions under the general Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified ... and adherence to policy through practice analysis and case review of APPs with physicians. + Investigate and respond...experience as a licensed advanced practice provider: (Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist … more
- LA Care Health Plan (Los Angeles, CA)
- …and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The ... Registered Nurse - Payment Integrity Nurse Coder...inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to… more
- University of Utah (Salt Lake City, UT)
- Details **Open Date** 06/18/2025 **Requisition Number** PRN42207B **Job Title** PS Clinical Nurse Specialist **Working Title** Clinical Research Nurse **Job ... Rate Range** 60000 to 90400 **Close Date** 10/12/2025 **Priority Review Date (Note - Posting may close at any...patients based on specialty area. Problem Solving The Clinical Nurse Specialist makes decisions independently and in… more
- UPMC (Pittsburgh, PA)
- …+ Knowledge of computer technology, quality assurance activities, DRG, and Quality Insights/ Utilization review background is highly preferred. + Ability to ... diplomatic manner required. **Licensure, Certifications, and Clearances:** + Certified Coding Specialist (CCS) OR Certified Registered Nurse Practitioner OR… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …+ 1 year of clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization experience is preferred. + ... Working in a fast-paced, high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …+ 1 year clinical and/or related experience required. + Case Management, Utilization Review , Oncology, Cellular Therapy and/or Prior Authorization experience is ... The Cell Therapy Clinical Authorization Specialist is responsible for the comprehensive coordination and management of all prior authorization activities specific to… more