- 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 (Little Rock, AR)
- …organization offering competitive benefits including a fresh perspective on workplace flexibility. Clinical Review Nurse - Concurrent Review & Outpatient ... 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
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Medical Director, Clinical Review and Care Integrity** to join #TeamMVP. If you have ... a passion for collaboration and clinical leadership, quality improvement and medical decision making this...a recognized specialty + Minimum of 5 years of clinical practice experience + Managed care, utilization management, or… more
- Centene Corporation (Phoenix, AZ)
- …resolution and logs of actions and/or decisions are appropriately documented + Performs clinical review of outcomes including creating and editing denial letters ... with Federal, State, and NCQA standards + Investigates denials through comprehensive review of clinical documentation, clinical criteria/guidelines, and… more
- Actalent (Fort Lauderdale, FL)
- Job Title: Clinical Review Nurse Job Description As a Clinical Review Nurse, you will perform concurrent reviews to assess members' overall health, ... review the type of care being delivered, evaluate medical...Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual and Medicare + Expertise… more
- Children's Mercy Kansas City (Kansas City, MO)
- …improve the lives of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based ... from admission through hospital stay to discharge. Adeptly uses evidence based clinical practice guidelines to determine the appropriate level of care and the… more
- Actalent (Atlanta, GA)
- Job Title: Clinical Review NurseJob Description: The Review Nurse will be responsible for reviewing approximately 20 cases a day to assess medical necessity ... decisions and gather additional information about the member's condition. Responsibilities: + Review approximately 20 cases a day for medical necessity. + Advocate… more
- St. Luke's Health System (Meridian, ID)
- **Overview** At St. Luke's, our dedicated team of Clinical Review Nurses strive to build a positive, supportive, and inclusive culture that delivers exceptional ... City** _Boise_ **Category** _Nursing - Experienced_ **Work Unit** _Clinical Review Management System Office_ **Position Type** _Full-Time_ **Work Schedule**… more
- Hackensack Meridian Health (Edison, NJ)
- …transform healthcare and serve as a leader of positive change. The **Sleep Clinical Review Technician** is responsible for clinical history, signs/symptoms, ... diagnosis code and test order review . Works directly with team members and ordering clinicians and their staff to educate and support appropriate documentation for coding, authorizations and appropriate testing. This position will offer a hybrid schedule.… more
- LifePoint Health (Henderson, NC)
- …awards programs . And much more *Position Summary* Conducts chart audits/reviews for clinical practice guidelines, death review , blood review , core measures ... of CMS, TJC when performing chart abstractions for these entities. Performs clinical concurrent review , conducts team meetings, and coordinates internal… more
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