- Equitable (Charlotte, NC)
- Clinical Review Nurse , Disability Claims ( 25000067 ) **Primary Location** : UNITED STATES-NC-Charlotte **Other Locations** : UNITED STATES-Remote, UNITED ... join an organization that will help unlock your potential? Equitable is seeking a Clinical Review Nurse to join our Group Disability Claims team. The … more
- Centene Corporation (Sacramento, CA)
- …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 (Indianapolis, IN)
- …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
- Blue KC (MO)
- …**Employee discount program** **Job Description Summary:** Utilizes a collaborative review process of benefits, minimally necessary clinical information ... benefits and/or individual consideration reimbursement allowables using varied and broad clinical expertise. Acts as a member and provider advocate promoting and… more
- Munson Healthcare (Traverse City, MI)
- …using very specific timelines, assessments and evaluations. Tasks and processes of a clinical research nurse : + Review /screen new and established patients ... areas including neurology, cardiology, cardiothoracic surgery among others. A clinical nurse provides patient care. A research... trials + Approach providers about the studies for review + Facilitate the informed consent process and ensure… more
- R1 RCM (Detroit, MI)
- …AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to ... production-drive position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal… more
- UCLA Health (Los Angeles, CA)
- Description The Quality Management Clinical Nurse Specialist 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… more
- HCA Healthcare (Reston, VA)
- …next step in your career path, we encourage you to apply for our RN Clinical Resource Nurse opening. We review all applications. Qualified candidates will ... **Description** **Introduction** Do you have the career opportunities as a RN Clinical Resource Nurse you want in your current role? We invest in what matters… 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
- Community Health Systems (Sarasota, FL)
- (Full-Time, Remote) The Clinical Review Analyst is a professionally licensed nurse /LPN who is responsible for effectively managing the denial/appeal process ... via the performance of comprehensive analytic reviews of clinical and claim documentation. The CRA will perform triage,...reimbursement for care delivered to patients. As a _Clinical Review Analyst_ at Community Health Systems, you'll play a… more