- 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, ... through hospital stay to discharge. Adeptly uses evidence based clinical practice guidelines to determine the appropriate level of...are all preferred. + One of the following: Licensed RN - MO, Registered Nurse … more
- Actalent (Eugene, OR)
- Job Title: Clinical Review Nurse - Prior...expertise + Licensed Practical Nurse (LPN) or Registered Nurse ( RN ) certification + 2-4 ... Skills + Clinical review experience + Prior authorization...a Bachelor's degree in Nursing (BSN) + Washington State RN or LPN license + Electronic Health Portal-based usage… more
- Actalent (Eugene, OR)
- …Skills + Licensed Practical Nurse (LPN) or Registered Nurse ( RN ) certification. + Clinical review and prior authorization experience. + 2-4 years ... Job Title: Clinical Review Nurse - Prior Authorization Job Description This role involves analyzing all prior authorization requests to determine the medical… more
- Actalent (Cincinnati, OH)
- Job Title: Clinical Review Nurse 100% Remote Eastern and Central time zones Job Description The Review Nurse will be responsible for reviewing ... and discharge planning. + Proficiency with InterQual. + Active Compact RN /LVN/LPN License. + Utilization Management/Concurrent Review experience. + ICU/ER… more
- Centene Corporation (New York, NY)
- …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: ... 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
- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + ... Utilization Management Nurse !Job Description The Utilization Management Nurse ...to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness,… more
- Centene Corporation (Jefferson City, MO)
- …senior management to identify and implement opportunities for improvement. + Performs clinical review of outcomes including creating and editing denial letters ... and maintenance with the correspondence team + Investigates denials through comprehensive review of clinical documentation, clinical criteria/guidelines, and… more
- Beth Israel Lahey Health (Burlington, MA)
- …degree in Science. **Licensure, Certification, Registration:** Currently licensed as a Registered Nurse in the State of Massachusetts **Skills, Knowledge ... CV Service line manager and the Medical Director of the Clinical Service, the Cardio Serv Clin Rev Nurse works to ensure all database forms are accounted for,… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …and leadership programs + And more **Description** The Clinical **Utilization Review Nurse Preceptor (UR RN Preceptor)** will be responsible ... for training, mentoring, and coaching for the Utilization Review Department. The UR RN Preceptor must...Review process in its entirety. + The UR RN Preceptor will have expert clinical skills… more
- Children's Mercy Kansas City (Kansas City, MO)
- …resolve issues. The High-Risk Nurse Lead is an expert at the roles of Clinical Review Nurse Care Manager and Care Coordination Case Manager and provides ... administrative processes and data related to medical necessity denials, clinical appeals, long length of stay rounds, and clinically/financially...a previous role + One of the following: Licensed RN - MO, Registered Nurse … more