- Harbor Health Services, Inc. (Mattapan, MA)
- …including UM/CM, Grievance and Appeals, inpatient and outpatient services, medical policy, and clinical claims review In-depth experience of Mass Health and ... support to utilization team. Utilizes evidence-based standards and clinical expertise to review current role expectations,...with UM RNs and Senior Medical Director to deny claims when appropriate. Attends IDT meetings on routine basis.… more
- Aveanna Healthcare LLC (Madison, WI)
- …patient admissions and continuity of care are held. Monitor and review client satisfaction survey results across branches, developing and implementing improvement ... in the day to day branch management including comprehensive review of financial statements, business planning, P&L responsibilities, productivity reports/staffing,… more
- Alameda Health System (Oakland, CA)
- …background. Required Licenses/Certifications : Valid license to practice as a Registered Nurse in the State of California. Preferred Licenses/Certifications ... Their responsibilities span from managing admissions to ensuring clean claims , identifying trends, and optimizing resource utilization. This role supports… more
- Geisinger (Wilkes-Barre, PA)
- …the goal of providing seamless support for patients. At least 5 years of Registered Nurse work experience is required. BSN is required. The ideal candidate ... a rewarding, lasting career with impact. Job Duties The Clinical Risk & Patient Safety RN is...Minimum of 5 years-Nursing (Required) Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania… more
- The County of Los Angeles (Los Angeles, CA)
- …be active and unrestricted. Successful candidates are required to provide proof of their Registered Nurse ( RN ) License and Basic Life Support (BLS) ... REGISTERED NURSE I/RELIEF NURSE ...medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services… more
- The County of Los Angeles (Los Angeles, CA)
- REGISTERED NURSE I, SHERIFF (CORRECTIONAL HEALTH) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2930992) Apply REGISTERED NURSE ... is currently offering up to 20% bonus for full-time Registered Nurse I, Sheriff positions hired by...medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services… more
- CVS Health (Richmond, VA)
- …including NCQA standards. **Required Qualifications** + Candidate must have an active and unrestricted Registered Nurse ( RN ) License in Virginia OR Compact ... who cannot advocate for themselves. The TOC team will review prior claims to address potential impact...Registered Nurse ( RN ) License in state of residence… more
- InGenesis (Columbia, SC)
- InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work for our client located in Columbia, SC. In this role you will ... criteria and assess and monitor medical necessity using your clinical proficiency and claims knowledge. This is...Perform other duties as assigned. Minimum Qualifications * Current Registered Nurse / RN license… more
- CVS Health (Haddonfield, NJ)
- …to or within Passaic County, New Jersey + Candidate must have an active and unrestricted Registered Nurse ( RN ) license in New Jersey + Candidate must be ... opportunities to enhance a member's overall wellness. + Uses clinical tools and information/data review to conduct...Degree in Nursing (PREFERRED) **License** + Active and unrestricted Registered Nurse ( RN ) license in… more
- CVS Health (Reston, VA)
- …- RN with current unrestricted Virginia state licensure required - 3+ years clinical experience as a Registered Nurse (ie med surg, behavioral health, ... of network management and clinical coverage policies. Through the use of clinical tools and information/data review , conducts an evaluation of member's needs… more
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