- Actalent (Baton Rouge, LA)
- Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse plays a critical role in analyzing prior authorization requests to determine the ... cost-effectiveness of medical care. Responsibilities + Perform medical necessity and clinical reviews of authorization requests to determine the appropriateness of… 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 ... complete cases. Qualifications: + 3+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and discharge… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding ... adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical ...and mandates. + Organizes the appeal case for physician review by compiling clinical , contractual, medical policy… more
- Centene Corporation (Jefferson City, MO)
- …administered with quality, cost efficiency, and are within compliance. + Performs a clinical review and assessment of relevant complex post-care services by ... fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical retrospective review and assessment of complex...assigned + Complies with all policies and standards **Location: Remote (Must be able to work in Central Time… more
- Centene Corporation (Denver, CO)
- …management to identify and implement opportunities for improvement. + Oversees the clinical review of outcomes including creating and editing correspondence ... a fresh perspective on workplace flexibility. **Location: Position is remote . Prefer candidate to live in PST time zone.**...standards + Provides expert insight and guidance on the clinical review process of correspondence to ensure… 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
- Molina Healthcare (Rio Rancho, NM)
- …**Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory ... requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and… 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, ... benefits including a fresh perspective on workplace flexibility. NOTE: This is a fully remote role with a focus on NICU services. **Preference will be given to… more
- Centene Corporation (Austin, TX)
- …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
- State of Colorado (Pueblo, CO)
- NURSE III - Clinical Specialist - Pueblo Regional Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5186234) Apply NURSE III - ... minimum staffing standards. This includes covering as a team nurse as needed. This position exists as a unit...and Health Care Technicians/QMAP. + Through direct observations and review of documentation determines if nurses are practicing critical… more