- Evolent (Des Moines, IA)
- …while providing better health outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases, which do not pass ... staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You… 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
- Actalent (Eugene, OR)
- Job Title: Clinical Review Nurse - Prior AuthorizationJob Description This role involves analyzing prior authorization requests to assess the medical necessity ... for members. + Comply with all policies and standards. Essential Skills + Clinical review experience + Prior authorization expertise + Licensed Practical Nurse… more
- Centene Corporation (Little Rock, AR)
- …senior management to identify and implement opportunities for improvement. + Performs clinical review of outcomes including creating and editing denial letters ... and maintenance with the correspondence team + Investigates denials through comprehensive review of clinical documentation, clinical criteria/guidelines, and… more
- Actalent (Eugene, OR)
- Job Title: Clinical Review Nurse - Prior Authorization Job Description This role involves analyzing all prior authorization requests to determine the medical ... + Licensed Practical Nurse (LPN) or Registered Nurse (RN) certification. + Clinical review and prior authorization experience. + 2-4 years of prior authorization… more
- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + ... staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing… 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 (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
- Actalent (San Antonio, TX)
- 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
- Actalent (Dallas, TX)
- Clinical Review Nurse (Utilization Management)100% Remote Job Description The role of the Utilization Management Nurse involves performing concurrent reviews, ... Perform concurrent reviews to assess member's overall health. + Review the type of care being delivered and evaluate...Skills + 2+ years of utilization management and utilization review expertise. + Experience in concurrent review … more
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