- Evolent (Indianapolis, IN)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as... medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all… more
- Evolent (Indianapolis, IN)
- …for the mission. Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer , Nurse , you will be a key member of the utilization ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- Fresenius Medical Center (Clarksville, IN)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Fresenius Medical Center (Goshen, IN)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- Elevance Health (Indianapolis, IN)
- …required by law. ** Must be an Indiana resident ** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging cases that ... assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical ...management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience;… more
- International Medical Group (Indianapolis, IN)
- …suggesting new ideas and seeking process improvements. + Judgment - use of good clinical judgment in resolving questions of medical necessity as it relates to ... As one of the world's top International Medical Insurance companies, IMG helps individuals and companies...of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between… more
- Surgery Care Affiliates (New Albany, IN)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… more
- Elara Caring (South Bend, IN)
- …data or needs, physician orders or special instructions. + Participates in continual review and evaluation of clinical practices and learning activities to ... + Opportunities for advancement + Comprehensive insurance plans for medical , dental, and vision benefits + 401(K) with employer...of nursing. + 1+ year of experience as a nurse in a clinical setting. + Registered… more
- Gentiva (Marion, IN)
- …(LCD) criteria per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and ... Partnerships. Transform Hospice Care.** We are seeking a dedicated Hospice Nurse Practitioner to perform Face-to-Face (F2F) encounters essential for hospice… more
- Humana (Indianapolis, IN)
- …guidance where needed. Follows established guidelines/procedures. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals....TRICARE, all HGB policies and procedures as well as medical necessity review criteria and privacy requirements… more