- Evolent (Jackson, MS)
- …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
- Fresenius Medical Center (Oxford, MS)
- …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
- Cognizant (Jackson, MS)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. + Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. + Medical Necessity Reviews can… more
- Veterans Affairs, Veterans Health Administration (Biloxi, MS)
- …Care Coordinator possess intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical ... Summary The Community Care Coordinator Nurse is responsible for executing a streamlined approach...possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, … more
- Veterans Affairs, Veterans Health Administration (Jackson, MS)
- …and record relevant patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities Total Rewards of a Allied Health… more
- CoreCivic (Natchez, MS)
- …duplication of those services. + Maintain absolute security and confidentiality of all medical records. Review medical files to determine all provided ... the highest quality care in an institutional setting. The Advanced Registered Nurse Practitioner under the supervision of the facility physician, provides advanced… more
- Datavant (Jackson, MS)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more
- Humana (Jackson, MS)
- …effectively communicate a meaningful narrative with those findings + Proven ability to perform clinical reviews and review medical records + Ability to ... of our caring community and help us put health first** The Senior Clinical Medical /Financial Risk Evaluation Professional is responsible for supporting the… more
- Evolent (Jackson, MS)
- …The Specialty Appeal nurses work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators who set up the ... appeal, Physicians and other Clinicians who review the appeal, and managers for direction and leadership....to company policies and procedures. + Documents communications with medical office staff and/or MD provider as required. +… more
- CenterWell (Bruce, MS)
- …policies and standards. + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by ... position comes with a $10K sign-on bonus.** + The ** Clinical Manager** coordinates and oversees all direct care patient...Utilization Review staff. Upon completion of the assessment, creates and… more