- Molina Healthcare (WI)
- …DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate ... Appeals and Grievances department. We are seeking a Registered Nurse with previous claims and appeals experience. The candidate...years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more
- University of Miami (Miami, FL)
- …please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Nurse Navigator - Site Disease Group - Remote ... Group has an exciting opportunity for a Per Diem Nurse Navigator. The Nurse Navigator is the...and assures timely scheduling of initial appointments. Reviews outside medical records for appropriate scheduling. Assess barriers to care… more
- Molina Healthcare (Long Beach, CA)
- **JOB DESCRIPTION** **Job Summary** The **Delegation Oversight Nurse ** is responsible for ensuring that Molina Healthcare's UM delegates are compliant with all ... as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
- Ochsner Health (New Orleans, LA)
- …expertise as well as knowledge of utilization and discharge planning criteria to review medical information of prior hospitalized patients that are being ... options affecting OHS revenue as it relates to all medical necessity audits. **Education** Required - Registered Nurse...care as an RN. Experience in Case Management, Utilization Review and/or Discharge Planning .either in the Acute Care… more
- 315 health (Warner Robins, GA)
- …confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and ... management of their health through continuous care programs like Remote Patient Monitoring and Chronic Care Management. Our team works fervently to anticipate the… more
- Medical Mutual of Ohio (OH)
- …pre-employment substance abuse and nicotine testing._ **Title:** _Clinical Appeal & Claim Review Nurse II_ **Location:** _Ohio_ **Requisition ID:** _2500127_ ... stay and level of care. + Extrapolates and summarizes medical information for physician review or other...degree preferred. + 3 years experience as a Registered Nurse in acute care, critical care, emergency medical… more
- University of Miami (North Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... SoLe Mia has an exciting opportunity for a Registered Nurse . CORE JOB SUMMARY The Registered Nurse ...to changing work demands and environment. Operates the appropriate medical equipment. . Adheres to University and unit-level policies… more
- University of Miami (Hialeah, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Location: ... provider(s) and assures timely scheduling of initial appointments.2. Reviews outside medical records for appropriate scheduling.3. Assess barriers to care and refers… more
- Mosaic (Liberal, KS)
- …tasks according to Mosaic policies and state licensing requirements. + Maintain and review medical records of individuals served to monitor pertinent concerns ... that puts people first. We're looking for a Registered Nurse to join our team! With so many moving...monitor all aspects of an individual's care, including all medical /psychiatric concerns. Who will love this job: + A… more
- R1 RCM (Detroit, MI)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Utilization Review Nurse ** , you will help our hospital clients by ... **Location:** Remote , US **Shift:** Weekend Evening schedule **Fri/Sat/Sun/Mon 2...**Here's what you will experience working as a Utilization Review Nurse :** + Perform initial admission and… more