- Kaiser Permanente (Pleasanton, CA)
- …and developing mitigation plans for all occurrences which may lead to medical center liability adjusting to remove barriers and/or issues, as necessary; supporting ... the medical centers continuous survey readiness program to maintain compliance...improvement evaluations, special projects, and other work for multidisciplinary review ; investigating opportunities to improve the reporting and narrative… more
- Molina Healthcare (Rio Rancho, NM)
- JOB DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal ... nursing experience, including at least 1 year of utilization review , medical claims review , long-term...equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active and unrestricted in… more
- STG International (Rockville, MD)
- STGi is currently seeking a Registered Nurse -Case Review Specialist . The position is remote and open to candidates nationwide. JOB SUMMARY: Provides direct ... with FOH Business Operations team. Serves as a Registered Nurse Case Review Specialist for the case... Corps - 60J, 60L, 61F, 61H, 61N, 61R,62B Medical Specialist Corps - 65B, 65C, 65D Nurse… 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 seeking an experienced Registered Nurse to join our team within a leading Managed...a leading Managed Care Organization. This role is fully remote and focuses on reviewing clinical documentation to determine… more
- Actalent (Baton Rouge, LA)
- Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse plays a critical role in analyzing prior authorization requests to determine the ... medical necessity of services and the appropriate level of...healthcare providers and the authorization team to ensure timely review of services and requests, ensuring members receive authorized… more
- Actalent (Tampa, FL)
- Urgent Hiring for " Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and ... complete cases. Qualifications: + 3+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and discharge… more
- CVS Health (Topeka, KS)
- …do it all with heart, each and every day. **Position Summary** **This is a remote work from home role anywhere in the US with virtual training.** American Health ... Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...**Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- CareFirst (Baltimore, MD)
- …and Grievances in a healthcare payor organization. 2 years' experience in Medical Review , Utilization Management or Case Management at CareFirst BlueCross ... (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Medical Review **Equal Employment Opportunity** CareFirst BlueCross… more
- Trinity Health (Albany, NY)
- …Brings patient to exam room, takes appropriate vital signs and documents in electronic medical record. + Review and update medication list to ensure accurate and ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Registered Nurse - Endocrinology - Albany, NY** If you are...complete list in electronic medical record (EMR) available for provider review … more
- CVS Health (Phoenix, AZ)
- …healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role, you'll be at ... times may vary based on business needs. Location: 100% Remote (US only) **About Us** American Health Holding, Inc....(AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible,… more
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