- Centene Corporation (Little Rock, AR)
- …national organization offering competitive benefits including a fresh perspective on workplace flexibility. Clinical Review Nurse - Concurrent Review & ... be 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,… more
- Children's Mercy Kansas City (Kansas City, MO)
- …can improve the lives of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, ... from admission through hospital stay to discharge. Adeptly uses evidence based clinical practice guidelines to determine the appropriate level of care and the… more
- Actalent (Fort Lauderdale, FL)
- Job Title: Clinical Review Nurse Job Description As a Clinical Review Nurse , you will perform concurrent reviews to assess members' overall ... health, review the type of care being delivered, evaluate medical...Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual and Medicare + Expertise… 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
- Actalent (Atlanta, GA)
- Job Title: Clinical Review NurseJob Description: The Review Nurse will be responsible for reviewing approximately 20 cases a day to assess medical ... requires following various procedures and processes to complete authorizations successfully. The nurse will collaborate with a team of nurses and communicate with… more
- Centene Corporation (Phoenix, AZ)
- …resolution and logs of actions and/or decisions are appropriately documented + Performs clinical review of outcomes including creating and editing denial letters ... State, and NCQA standards + Investigates denials through comprehensive review of clinical documentation, clinical ...preferred. **License/Certification:** + RN or LPN - Licensed Practical Nurse - State Licensure required Pay Range: $30.00 -… 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
- Beth Israel Lahey Health (Burlington, MA)
- …Under the direction of the CV Service line manager and the Medical Director of the Clinical Service, the Cardio Serv Clin Rev Nurse works to ensure all database ... from multiple sources within a patient's medical record. 3. Adheres to specific clinical data abstraction guidelines and standards, such as those set by the American… more
- Actalent (Miami, FL)
- Urgent Hiring for "Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and protect ... complete cases. Qualifications: + 2+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and discharge… more
- HCA Healthcare (Vidalia, GA)
- …next step in your career path, we encourage you to apply for our Registered Nurse Clinical Float opening. We review all applications. Qualified candidates ... **Description** **Introduction** Do you have the career opportunities as a **Registered Nurse Clinical Float** **(Float Pool)** you want in your current role? We… more
Recent Jobs
-
Pain Management Physician / Anesthesiologist
- Dartmouth Health (Bennington, VT)
-
Regional Sales Executive (Account Manager)
- Dealer e Process (Philadelphia, PA)