- University Health (San Antonio, TX)
- …appropriate for the services needed to be rendered. This position requires assertive clinical acumen and communication skills for serving in the liaison roles with ... full-time hospital experience preferred. Work experience in case management, utilization review or hospital quality assurance experience is preferred. Must complete… more
- University Health (San Antonio, TX)
- …advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve ... hospital experience preferred. Work experience in case management, utilization review , or hospital quality assurance experience is preferred. LICENSURE/CERTIFICATION… more
- Abbott (Kansas City, MO)
- …, with a schedule of **Monday-Friday, 8:00 AM - 5:00 PM** . The position of Clinical Review Nurse is within our Toxicology division located at our **Kansas ... City, MO** site within Workplace Solutions. In this role, the ** Clinical Review Nurse ** is responsible for accuracy and integrity of the Workplace Solutions… more
- Centene Corporation (Denver, CO)
- …management to identify and implement opportunities for improvement. + Oversees the clinical review of outcomes including creating and editing correspondence ... State, and NCQA standards + Provides expert insight and guidance on the clinical review process of correspondence to ensure compliance with all applicable… more
- Centene Corporation (New York, NY)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... and cost effectiveness of medical care. + Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in… more
- Centene Corporation (Baton Rouge, LA)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- Evolent (Lansing, MI)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Catholic Health (Kenmore, NY)
- … to patients and families in the hospital setting. Utilizing foundational nursing clinical skills Utilization Review nurse collaborates with the ... Rotation Hours: 8 am- 4 pm Summary: The Registered Nurse (RN), Utilization Review , as an active...payers strongly preferred KNOWLEDGE, SKILL AND ABILITY + Strong clinical assessment skills and ability to articulate findings in… more
- UCLA Health (Los Angeles, CA)
- Description The Quality Management Nurse is responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with healthcare standards and ... regulations. This role involves evaluation clinical practices, identifying areas for improvement, and implementing quality improvement initiatives to enhance patient… more
- UCLA Health (Los Angeles, CA)
- … documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role...benefit coverage. + Applies UCLA Health protocols and national clinical guidelines (eg, InterQual, Milliman) in review … more
