- Guthrie (Cortland, NY)
- …needed for patient that have arrived without orders. Prepare educational materials for the RN Nurse Navigator for Chemo Education Visits per the instruction and ... determination of coverage of ordered medications. *Coordinate and complete appeals for denials as needed *Monitor and Review REMS...offices and for DBL office as needed Coverage for RN Nurse Navigator *Coordinate and facilitate completion… more
- Medtronic (MN)
- …authorization or utilization review + Professional license or credentials (MA, LPN, RN ) with clinical nursing experience preferred + Understanding of healthcare ... and initiate as requested by customer. + Coordinate required paperwork and clinical notes for submission in a timely and comprehensive manner as required.… more
- State of Colorado (Denver, CO)
- …of health care including physical, psychiatric, and dental maintenance. Clinical Management: Functions as the facility responsible health authority (RHA). ... to include students and interns. Point of contact for the local schools for RN , NP or PA students. Facilitates regular staff meetings. Data and Reporting: Collects… more
- BriteLife Recovery (Englewood, NJ)
- …and continued stay authorizations from insurance payers by effectively communicating clinical information and advocating for appropriate levels of care. The UR ... Specialist works closely with clinical staff, admissions, medical providers, and third-party payers to...metrics to support organizational performance improvement. + Assist in appeals and peer reviews by gathering required documentation and… more
- State of Colorado (Pueblo, CO)
- …according to CMS requirements. + Keep a record of due dates for RN annual assessments, and Social Work and Psychiatric biannual assessments, and send reminders ... Utilization Review Manager, weekly, at a minimum. + Schedules clinical consultation meetings for provider/ clinical team member...the department's action. + For more information about the appeals process, the official appeal form, and how to… more
- CommonSpirit Health Mountain Region (Westminster, CO)
- …the workplace each day, qualified candidates will need the following: + 3 years RN experience, required + 1-year clinical leadership experience, required + High ... care for orthopedic, abdominal, and general surgeries. 5 West appeals to anyone interested in broadening their skillset as...greater cause is something we value even more. The Clinical Nursing Manager is responsible for the management of… more
- Banner Health (Phoenix, AZ)
- **Primary City/State:** Phoenix, Arizona **Department Name:** Clinical Decision Making **Work Shift:** Day **Job Category:** Physicians The Senior Medical Director, ... Network Performance is a senior clinical executive responsible for advancing the performance of Banner Health's network of employed and contracted providers across… more
- Commonwealth Care Alliance (Boston, MA)
- …with utilization review, ideally experience with public programming, and excellent clinical judgment. They will work well both independently and in conjunction ... Responsibilities:** + Primary responsibility for performing daily medical reviews, appeals as appropriate, correspondence regarding review determinations and physician… more
- Centene Corporation (Jefferson City, MO)
- …& coding, coding/data analysis, accounting/business or physician/hospital data management or RN /LPN and 2+ years of related clinical experience. Experience ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- CommonSpirit Health Mountain Region (Westminster, CO)
- …day, qualified Assistant Nurse Manager candidates will need the following: + 2 years clinical RN experience + 6 months - 1 year clinical leadership ... provide excellent patient-centered care with teamwork and compassion. Our department appeals to anyone interested in furthering their skillset, specifically in the… more