- Abbott (Kansas City, MO)
- …, with a schedule of **Monday-Friday, 8:00 AM - 5:00 PM** . The position of Clinical Review Nurse is within our Toxicology division located at our **Kansas City, ... MO** site within Workplace Solutions. In this role, the ** Clinical Review Nurse** is responsible for accuracy and integrity of the Workplace Solutions drug… more
- Centene Corporation (Jefferson City, MO)
- …administered with quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review of services previously provided to determine… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Centene Corporation (Denver, CO)
- …management to identify and implement opportunities for improvement. + Oversees the clinical review of outcomes including creating and editing correspondence ... and NCQA standards + Provides expert insight and guidance on the clinical review process of correspondence to ensure compliance with all applicable State and… more
- Actalent (St. Louis, MO)
- Remote Clinical Review Nurse - Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role We are ... Care Organization. This role is fully remote and focuses on reviewing clinical documentation to determine medical necessity, appropriateness of care, and alignment… more
- Abbott (Kansas City, MO)
- …Our 114,000 colleagues serve people in more than 160 countries. **Senior Supervisor, Clinical Review ** **Working at Abbott** At Abbott, you can do work ... conditions. **On-site role in Kansas City, Missouri** The **Senior Supervisor, Clinical Review ** position is part of our Rapid Diagnostics business. This role… more
- Baystate Health (Springfield, MA)
- …Minimum - Midpoint - Maximum $87,859.00 - $100,984.00 - $119,412.00 **UM Outpatient Clinical Review Nurse- Baystate Health, Health New England** **This is a ... **.** **Current States Eligible MA and CT** The **UM Outpatient Clinical Review Nurse** contributes to the overall success of the Utilization Management… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Martin's Point Health Care (Portland, ME)
- …Summary The Supervisor is responsible for day-to-day operations of the utilization review clinical team, in the areas of authorization requests, organizational ... management experience in a managed care setting including utilization review + RN experience in a clinical ...utilization review + RN experience in a clinical setting + Leadership and/or management experience preferred +… more
- HCA Healthcare (Ocala, FL)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have ... caring group of colleagues. Do you want to work as a Clinical Denial Coding Review Specialist where your passion for creating positive patient interactions is… more
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