• RN Clinical Review Appeals…

    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
    St. Luke's University Health Network (07/08/25)
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  • Clinical Review Nurse - Concurrent…

    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
    Centene Corporation (07/18/25)
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  • Medical Director, Clinical Review

    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
    MVP Health Care (08/04/25)
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  • Senior Clinical Review Nurse…

    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
    Centene Corporation (07/19/25)
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  • Clinical Review Nurse

    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 (08/01/25)
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  • Clinical Review Nurse Care Manager

    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
    Children's Mercy Kansas City (06/18/25)
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  • Clinical Review Nurse

    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
    Actalent (08/02/25)
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  • Clinical Review Management Liaison…

    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
    St. Luke's Health System (07/19/25)
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  • Sleep Clinical Review Technician

    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
    Hackensack Meridian Health (06/14/25)
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  • Clinical Quality Review & Sepsis…

    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
    LifePoint Health (06/20/25)
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