- Constructive Partnerships Unlimited (Brooklyn, NY)
- …medical issues with VP of Nursing, Nurse Administrator, Registered Nurse ( RN ), and Medical Coordinators2. Maintains medical records, including ... health recordse. As directed by the VP of Nursing/ Nurse Administrator debrides hard copy of medical ...stationery supplies.23. Perform data entry tasks accurately and efficiently. Review data for deficiencies or errors.24. Assist with special… more
- AdventHealth (Hinsdale, IL)
- …of clinical experience preferred + Experience with quality and peer reviews preferred + Registered Nurse ( RN ) credentialed from the Illinois Board of ... claims , quality indicators and other risk-related data. + Coordinates the medical staff's professional performance evaluation and peer review programs in a… more
- St. Luke's Health System (Boise, ID)
- …for utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims payment policies and ... is truly a great place to work. The **Director of Clinical Review Management** provides strategic and operational leadership across multiple settings and operating… more
- San Antonio Behavioral Health (San Antonio, TX)
- …May consult with staff as needed. Essential Duties: + Collaborate and set standards with registered nurse ( RN ) case managers (CMs) and outcome managers to ... The Utilization Review Coordinator conducts utilization reviews to determine if...and extended hospitals stays. Completing data collection of demographics, claim and medical information; non- medical … more
- ICW Group (San Diego, CA)
- …Discharge Planning, or Home Health preferred. **CERTIFICATES, LICENSES, REGISTRATIONS** Current unrestricted Registered Nurse ( RN ) or Licensed Vocational ... assessment and evaluate needs for treatment in worker's compensation claims . The Telephonic Nurse Case Manager will...Nurse Case Manager will negotiate and coordinate appropriate medical treatment and length of disability with providers and… more
- BronxCare Health System (Bronx, NY)
- …Licensed Practical Nurse : Under the direct supervision of a physician and/ or Registered Nurse , participates in the application of the nursing process to an ... (according to the NPSG), intake screening of patient, pre-visit planning (if applicable), review of medical record to determine visit requirements such as HEIDS… more
- Veterans Affairs, Veterans Health Administration (Jamaica Plain, MA)
- …appointments. Telephone and video care are encouraged. Each physician is assigned a registered nurse , clinical associate, and scheduler. There is no call, and ... are seeking an enthusiastic internist with a passion for medical education for a full time position as ...VHA Education Loan Repayment Services program office after complete review of the EDRP application. EDRP Authorized: Contact VHA… more
- LA Care Health Plan (Los Angeles, CA)
- …Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese. Licenses/Certifications Required Registered Nurse ( RN );current and unrestricted California ... health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health Homes… more
- The Hartford (Hartford, CT)
- …In this position, the individual will perform Drug Review / Utilization Review for Workers' Compensation Claims . An Initial Clinical Reviewer (ICR) is ... cases where additional information is required to complete the review and/or identify potential medical necessity cases....This position will also be cross trained in Utilization Review Qualifications: + RN with current unrestricted… more
- HCA Healthcare (Hopewell, VA)
- …of Science in Nursing or related field - Required Master of Science - Preferred Registered Nurse License in state in which he or she practices - Required ... HCI, the Division Vice President of Quality, Division Chief Medical Officer, Division Claims Administrator, HCA Patient...and probability of legal action for submission of Probable Claim Report (PCR) to HCI. Balance Systems and Individual… more