- HCA Healthcare (Austin, TX)
- …to the Maternal Program Manager using facility approved audit tools. As the NICU Clinical Nurse Reviewer , . You will review patient's medical record and ... St. David's North Austin Medical Center our nurses set us apart from any other healthcare provider. We are...any other healthcare provider. We are seeking a(an) Clinical Nurse Reviewer Neonatal ICU to join our… more
- Chenega Corporation (Rockville, MD)
- …a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States . + Must be local to Rockville, MD and able to travel to ... **Chenega Professional Services Strategic Business Unit** company, is looking for a Nurse Practitioner-Contract Medical Reviewer (CMR) to support the Department… more
- Elevance Health (Independence, OH)
- …coverage (Sat & Sun 8am-12pm CST, with a comp day during the week) The ** Nurse Reviewer I** is responsible for conducting preauthorization, out of network and ... on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners with… more
- Evolent (Olympia, WA)
- …peer clinical review activities while located in a state or territory of the United States . Acts with honor and integrity, serving as a role model for the ... mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance… more
- AmeriHealth Caritas (Lafayette, LA)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines ... Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. **Licensure:** + An active Registered Nurse (RN)… more
- AmeriHealth Caritas (Washington, DC)
- …When necessary, cases are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines ... on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the appropriateness of services, identifies care coordination opportunities,… more
- Adecco US, Inc. (Minneapolis, MN)
- …days **Pay:** $40.50 to $42.50 an hour **Responsibilities of the RN Appeals Reviewer :** . Responsible for conducting thorough reviews of member and provider appeals, ... when appropriate. . You will summarize medical information for review by the Medical Director as needed, ensuring a...and meeting production goals. **Qualifications for the RN Appeals Reviewer :** . Associates degree . Active and good standing… more
- Chenega Corporation (Rockville, MD)
- …of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States . + Because our Physicians (Contract Medical Reviewers) spend significant ... Unit** company, is looking for a Physician- Contract Medical Reviewer (CMR) to support the Department of Health and...& Immunology, Neurology; or License to practice in the US as a physician's assistant or nurse … more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... + Process appeals, ensuring compliance with all regulatory milestones + Review medical records to identify Hospital-Acquired Conditions (HAC), ensure proper… more
- Zelis (FL)
- …Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare ... interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay… more
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