- Centene Corporation (Little Rock, AR)
- …offering competitive benefits including a fresh perspective on workplace flexibility. Clinical Review Nurse - Concurrent Review & Outpatient Services ... overall health and appropriate level of care + Reviews quality and continuity of care by reviewing acuity level,...care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... and competent manner. Processes all prior authorizations to completion utilizing appropriate review criteria. Identifies and refers all potential quality issues… more
- Staffing Solutions Organization (Augusta, ME)
- …which is a reflection of our clients and the people they serve. **Registered Nurse - Authorization Review Unit - MaineCare in Augusta, ME** **Position Duties:** ... by the PA supervisor, utilizing PA software tools; + Review and authorize provider requests for the following services...work queues and complete assigned tasks; + Conduct regular quality assurance reviews of decided PAs; + Collaborate with… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance ... This position will participate in ongoing professional development activities, quality improvement, and continuing education activities. This role Improves… more
- Actalent (Orlando, FL)
- Job Title: Clinical Review Nurse Job Description As a Clinical Review Nurse , you will perform concurrent reviews to assess members' overall health, ... review the type of care being delivered, evaluate medical...be part of a dynamic team committed to delivering high- quality care. Pay and Benefits The pay range for… more
- US Tech Solutions (Chicago, IL)
- …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... development and ongoing implementation of QM Work Plan activities. + Improve quality products and services, by using measurement and analysis to process, evaluate… more
- CVS Health (Dover, DE)
- …to meet quality and metric expectations. **Required Qualifications** + Registered Nurse (RN) - active license. + 3+ Years of clinical experience. + 1+ ... a collaborative process to implement, coordinate, monitor and evaluate medical review cases. Applies the appropriate clinical criteria/guideline and plan language or… more
- Centene Corporation (New York, NY)
- …benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. + Performs medical necessity ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more
- AmeriHealth Caritas (LA)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines to ... in decision-making. Productivity expectations include meeting established turnaround times, quality benchmarks, and efficiency metrics in a fast-paced environment.… more
- AmeriHealth Caritas (Washington, DC)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines to ... in decision-making. Productivity expectations include meeting established turnaround times, quality benchmarks, and efficiency metrics in a fast-paced environment.… more
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