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Clinical Nurse Reviewer Jobs

Nurse Reviewer Jobs
By Medical Mutual of Ohio At ,
Keeps up to date on utilization management regulations, policies and practices.
Acute inpatient level of care in Medical/Surgical/Critical Care/ ambulatory care experience preferred.
Intermediate Microsoft Office skills and proficiency navigating windows and web-based systems.
Knowledge of, and the ability to apply fundamental concepts related to HIPAA compliance and related regulations.
Knowledge of clinical practices and efficient care delivery processes.
Education reimbursement up to $5K per year
Clinic Risk Nurse Reviewer (Remote)
By Mercy At , Oklahoma City, 73120
Experience: At least 1 year of clinical experience
Education: Associate's or Bachelor's Degree
*This is a Remote Position*
*Strongly Prefer HCC Coding Experience*
*Looking for Clinic Nurse Reviewer/Risk Coder*
We're bringing to life a healing ministry through compassionate care.
Clinical Reviewer Jobs
By Numotion At Home, KS, United States
Six months medical documentation review related experience or training required.
Solid written and verbal communication, listening, organization and priority setting skills.
Maintain consistent and accurate follow-up on all assigned orders.
Communicate with Supervisor in regards to issues/changes with Payers.
Process all assigned orders in an accurate and timely manner.
Respond to all internal and external customers in a timely & professional manner
Ld Clinical Nurse Reviewer
By Phoenix Children's Hospital At , Phoenix
Collaborates with Lead Case Manager, Case Management Manager, Care Management Director and Utilization Medical Director.
Evaluates performance of Utilization Management technician and assists in completing performance appraisals.
Leveraging MCG evidence-based guidelines, coordinates, development and implementation of a comprehensive plan in collaboration with the Case Management Team.
Communicates with Utilization Management Leadership denials requiring a physician to physician conversation.
Attends insurance meetings with Utilization Management Medical Director and Care Management leadership as needed.
Attends Utilization Management meetings with Utilization Management Medical Director and Care Management leadership as needed.
Lpn Clinical Claims Reviewer (Hybrid/Remote Position)
By Chapters Health System At , Temple Terrace, 33637, Fl
Ensures departmental compliance with quality managements system and ISO requirements.
Improve own professional knowledge and skill level.
Minimum of two (2) years of hospice, palliative care, home health primary, and specialty care experience
Familiarity with Medicare, Medicaid, commercial and CMS managed care initiatives
Experience in Microsoft Outlook, Excel and Word
Excellent written and verbal communication skills
Clinic Risk Nurse Reviewer (Remote)
By Mercy At , Oklahoma City, 73120, Ok
Experience: At least 1 year of clinical experience
Education: Associate's or Bachelor's Degree
*This is a Remote Position*
*Strongly Prefer HCC Coding Experience*
*Looking for Clinic Nurse Reviewer/Risk Coder*
We're bringing to life a healing ministry through compassionate care.
Haq Clinical Reviewer - Remote | Wfh
By Get It Recruit - Healthcare At Walnut Creek, CA, United States

Are you ready to make a real impact in the world of healthcare? Join our dynamic Care Navigation department as a Health Assessment Questionnaire (HAQ) Reviewer and become an essential element in ...

Nurse Reviewer - Remote
By The Computer Merchant, LTD (TCM) At Anchorage, AK, United States

JOB TITLE:Nurse Reviewer - Remote

Clinical Reviewer - Medicare
By CareCentrix At United States
You have experience working remotely and are self-motivated.
You hold strong knowledge of Medicare PDGM and 1-2 years process experience strongly desired.
Develops/maintains a working knowledge of all CareCentrix services/guidelines/policies and accesses CareCentrix contract information, including the terms of the contract as appropriate.
You manage multiple tasks, are detail oriented, responsive, and demonstrate independent thought and critical thinking.
You possess strong computer skills, including the ability to navigate multiple internal systems, programs and external sites to conduct reviews.
You have a minimum of 1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health required.
Clinical Reviewer - Dme
By CareCentrix At United States
You have experience working remotely and are self-motivated.
You hold strong knowledge of Medicare PDGM and 1-2 years process experience strongly desired.
Develops/maintains a working knowledge of all CareCentrix services/guidelines/policies and accesses CareCentrix contract information, including the terms of the contract as appropriate.
You manage multiple tasks, are detail oriented, responsive, and demonstrate independent thought and critical thinking.
You possess strong computer skills, including the ability to navigate multiple internal systems, programs and external sites to conduct reviews.
You have a minimum of 1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health required.
Clinical Reviewer - Medicare (Remote)
By CareCentrix At United States
You have experience working remotely and are self-motivated.
You hold strong knowledge of Medicare PDGM and 1-2 years process experience strongly desired.
Develops/maintains a working knowledge of all CareCentrix services/guidelines/policies and accesses CareCentrix contract information, including the terms of the contract as appropriate.
You manage multiple tasks, are detail oriented, responsive, and demonstrate independent thought and critical thinking.
You possess strong computer skills, including the ability to navigate multiple internal systems, programs and external sites to conduct reviews.
You have a minimum of 1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health required.
Clinical Data Reviewer Jobs
By Natera At Austin, TX, United States
Partner with multiple internal cross-functional teams and successfully manage multiple product projects simultaneously.
Complete position responsibilities within the appropriate time frame while adhering to quality standards
Translate data into meaningful information and knowledge that supports decision making or determining action that drives performance improvement and quality
1+ years professional coding experience and understanding of International Classification of Diseases (ICD-10) and Coding Procedure Terminology (CPT) and HCPCS coding.
Superior organization skills, detail oriented, and ability to be persistent and follow through
Excellent communication skills, both verbal and written, particularly the ability to convey technical information in an accessible and understandable manner
Clinical Reviewer (Lpn/Rn - Remote)
By Acentra Health At Indianapolis, IN, United States
Are you an experienced Nurse Clinical Reviewer looking for a new challenge?
Strong clinical assessment and critical thinking skills required
Knowledge of InterQual or ASAM guidelines
Knowledge of InterQual or ASAM criteria strongly preferred
Knowledge of current NCQA/URAC standards strongly preferred
Excellent written and verbal communication skills
Clinical Data Manager / Medical Reviewer
By Albion Rye Associates At United States
Clinical Data Manager / Medical Reviewer
Contract until 31st December 2023
Please contact Jake Byrne at Albion Rye for more information or apply now for immediate consideration.
Clinical Nurse Reviewer (Remote)
By Acentra Health At Harrisburg, PA, United States

Good Verbal And Written Communication Skills Essential.

Medical Record Abstracting Skills Required.

Nurse Reviewer - Remote
By Fortuna BMC At United States
Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract
Maintains current knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license
Demonstrated proficiency in computer skills, and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers, etc.
5+ years clinical experience in an inpatient hospital setting required
Nurse Reviewer - Remote
By Fortuna BMC At Cochiti Pueblo, NM, United States
Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract
Maintains current knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license
Demonstrated proficiency in computer skills, and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers, etc.
5+ years clinical experience in an inpatient hospital setting required
Clinical Reviewer (Remote) Jobs
By Acentra Health At Charleston, SC, United States
Do you value care management and quality improvement?
Are you an experienced Clinical Reviewer looking for a new challenge?
Active unrestricted RN, SC State and/or Compact State clinical license per contract requirements.
Knowledge of InterQual criteria strongly preferred.
Knowledge of current NCQA/URAC standards strongly preferred
Medical record abstracting skills required.
Nurse Reviewer Jobs
By Fortuna BMC At United States
• Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
Remote or hybrid or in person and shift hours will be Alaska time
• Maintains current knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license
• 5+ years clinical experience in an inpatient hospital setting required
• 2+ years utilization review experience or claims auditing required
• Experience using Milliman or InterQual criteria required
Clinical Reviewer - Rn - (Remote)
By Acentra Health At Philadelphia, PA, United States
Managed Care and/or Case Management experience preferred.
Do you value care management and quality improvement?
Are you an experienced Clinical Reviewer looking for a new challenge?
Performs ongoing reassessment of review process to offer opportunities for improvement and/or change.
Bachelor’s degree or advanced certifications preferred.
Knowledge of current NCQA/URAC standards strongly preferred