- 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 ... guidelines to determine the appropriate level of care and the medical necessity of continued hospitalization. Secures initial payer authorization and continued… more
- Centene Corporation (New York, NY)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... hours.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance… more
- AmeriHealth Caritas (LA)
- …with medical policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical ... Degree in Nursing (BSN) preferred. + An active Registered Nurse (RN) license in good standing is required. +...and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care… more
- AmeriHealth Caritas (Washington, DC)
- …with medical policies. When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical ... document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, and… more
- Centene Corporation (Phoenix, AZ)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... Works with senior management to identify and implement opportunities for improvement. ** Remote position 12-9p CST would the hours Location PST/MST preferably.** +… more
- BJC HealthCare (St. Louis, MO)
- … experience performing care for hospitalized patients. + 2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity + Must ... team. This is a great opportunity for a local remote position. **Schedule** PRN (As needed) + Shifts will...care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In… more
- Humana (Columbus, OH)
- …first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support the coordination, documentation ... and communication of medical services and/or benefit... services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require… more
- HCA Healthcare (Mcallen, TX)
- …we support our colleagues in their positions. Join our Team as a Clinical Nurse Coordinator Medical Post Surgical and access programs to assist with every ... certifications and job skills. Apply today for our Clinical Nurse Coordinator Medical Post Surgical opening and...Medical Post Surgical opening. Our team will promptly review your application. Highly qualified candidates will be contacted… more
- Veterans Affairs, Veterans Health Administration (Loma Linda, CA)
- … Center's Risk Management Program and in accordance with regulatory, external review , VHA, VISN and Medical Center requirements. Responsibilities The Risk ... regarding legal and technical issues. The Risk Manager Supervisor nurse include oversight of Medical Legal Risk...principles and functions of Risk Management and the Peer Review Process. Work Schedule: TBD Virtual/ Remote : This… more
- CVS Health (Austin, TX)
- …do it all with heart, each and every day. **Position Summary** **This is a remote work from home role anywhere in the US with virtual training.** **Shift schedule is ... of residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...**Required Qualifications** + 5+ years' experience as a Registered Nurse (RN) with at least 1 year of experience… more
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