- HCA Healthcare (Houston, TX)
- …set us apart from any other healthcare provider. We are seeking a(an) Registered Nurse Clinical Reviewer to join our healthcare family. **Benefits** The Woman's ... their passion for patient care. Apply today for our Registered Nurse Clinical Reviewer opportunity. **Job Summary and Qualifications** We are seeking a… more
- State of Georgia (Fulton County, GA)
- Certification Reviewer - Registered Nurse or Licensed Practical Nurse Preferred- Atlanta Georgia - Fulton - Atlanta ... Share this Job Sign Up for Job Alerts Job Description Job Title: Certification Reviewer - Registered Nurse or Licensed Practical Nurse Preferred- Atlanta Pay… more
- Elevance Health (Tampa, FL)
- ** Nurse Reviewer I** **Location:** Tampa, FL Elevance Health supports a hybrid workplace model with PulsePoint sites (major office) used for collaboration, ... based within 50 miles of a PulsePoint site. The ** Nurse Reviewer I** will be responsible for...that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or… more
- HCA Healthcare (Conroe, TX)
- …next step in your career path, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. We review all applications. Qualified candidates ... **Introduction** Do you have the career opportunities as a(an) Registered Nurse Clinical Reviewer you want in your current role? We invest in what… more
- Elevance Health (San Juan, PR)
- …organization, providing information technology and business operations services for health plans._ ** Nurse Reviewer I** **Location:** This position will work a ... time zones that the unit will be supporting. The ** Nurse Reviewer I** is responsible for conducting...meets medical necessity criteria or requires additional medical necessity review . + Conducts initial medical necessity review … more
- Medical Mutual of Ohio (OH)
- …substance abuse and nicotine testing._ **Title:** _Acute & Post Acute Nurse Reviewer II_ **Location:** _Ohio_ **Requisition ID:** _2500099_ **Other ... Nursing Board. Bachelor's degree preferred. + 3 years as a Registered Nurse with a combination of clinical and or utilization/case management experience, preferably… more
- US Tech Solutions (Canton, MA)
- …extension)** Notes: Fully remote, MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that ... a clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical necessity and, therefore,… more
- Commonwealth Care Alliance (Boston, MA)
- …of community-based assessments for CCA members and ongoing tracking and monitoring. The RN MDS Reviewer is a member of the Minimum Data Set (MDS) Clinical Review ... team of the Care Planning Unit. The RN MDS Reviewer supports successful completion and submission of the MDS...form based on diagnoses / information gathered from record review . + Prepares printed MDS forms for data entry.… more
- Catholic Health (Buffalo, NY)
- …related to DRG and level of care denial trends. Responsibilities: EDUCATION + Registered Nurse with a current New York State license + Bachelor of Science Nursing ... degree + Holds, or will obtain within one (1) year of hire, one of the following (or similar) credentials: Certified Documentation Specialist, Certified Coder (CPC/CCS), Certified Processional Medical Auditor (CPMA), Certified Case Manager (CCM) or any other… more
- AmeriHealth Caritas (Charleston, SC)
- …and providers to collect all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer 's discretion to retain ... the direction of the Supervisor, the Behavioral Health Utilization Management Reviewer is responsible for completing medical necessity reviews. ;Using clinical… more