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Clinical Review Rn Jobs

Rn Regional Clinical Director
By CCH Healthcare At Pinehurst, NC, United States

RN Regional Clinical Director for a multi state skilled nursing and healthcare facilities for CCH Healthcare; we are seeking a RN Regional Clinical Director for part of a NC region. We are looking for ...

Rn - Clinical Care
By AHMC HealthCare At Daly City, CA, United States

Assues All Other Duties And Responsibilities As Necessary.

Clinical Quality Rn - State Of Louisiana
By UnitedHealthcare At , Metairie, 70002
Time Management- Must manage time appropriately, efficiently, and effectively
Provides individual and group education/training to clinical providers and staff related to clinical practice guidelines
Supports the Clinic Manager in efforts associated with responding to quality improvement initiatives by managed care plans
Conducts New Hire and Annual Skills training and assessment of Medical Assistants and LPNs
Analytical/Problem solving skills- identifies and resolves problems in a timely manner. Must be a strategic thinker
Planning/organizational skills- prioritizes and plans work activities, uses time efficiently and develops realistic actions plans
Concurrent Review Nurse, Rn - 23-246
By Hill Physicians Medical Group At , Sacramento

We’re delighted you’re considering joining us!

Rn, Clinical Supervisor Jobs
By Northside Hospital Inc. At , Atlanta, 30342

Overview: Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more ...

Clinical Review Coordinator - National Remote
By Optum At , Dallas, 75202
2+ years of Case Management experience
Experience in acute care, rehab, OR skilled nursing facility environment
Ability to work effectively in a self- management environment
Support new delegated contract start - up to ensure experienced staff work with new contracts
Perform other duties and responsibilities as required, assigned or requested
3+ years of clinical experience
Prn-Ur Clinical Review Rn - Support Center (Remote)
By Children's Healthcare of Atlanta At , Brookhaven, 30329

Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day ...

Manager Clinical Quality Review
By Johns Hopkins University At , Baltimore, 21218

EDUCATION LICENSURE & EXPERIENCE :

Benefits can be viewed here:

Medical Review Nurse (Government Outpatient Clinical Focus)
By Performant Financial Corporation At , Remote
Experience with utilization management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG) or InterQual.
Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse
Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits
Strong preference for experience performing utilization review for an insurance company, Tricare, MAC or organizations performing similar functions
Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding.
Knowledge of insurance programs program, particularly the coverage and payment rules.
Clinical Quality Review Specialist - Rn
By HCSC At , Richardson
Knowledge of managed care processes.
Organizational skills and ability to meet deadlines and manage multiple priorities.
Proficient with Milliman Care Guidelines (MCG) management.
5 years combine knowledge of healthcare processes.
Verbal and written communication skills to include interfacing with staff across organizational lines plus interfacing with members and providers.
PC experience to include Microsoft Word, Access, and Excel.
Benefit Review Rn - Remote | Wfh
By Get It Recruit - Healthcare At Philadelphia, PA, United States

Join our dynamic team and embark on an exciting journey in the world of healthcare management! We are seeking a passionate and dedicated individual to fill the role of Clinical Benefit Review ...

Medical Review Nurse (Government Outpatient Clinical Focus)
By Performant Corp At United States
Experience with utilization management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG) or InterQual.
Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse
Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits
Strong preference for experience performing utilization review for an insurance company, Tricare, MAC or organizations performing similar functions
Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding.
Knowledge of insurance programs program, particularly the coverage and payment rules.
Clinical Manager Opportunities (Rn Required)
By Piedmont Healthcare At , Atlanta, 30309

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:

Forbes named Piedmont one of Georgia’s 10 best employers and the highest-ranked healthcare provider.

Clinical Coach, Rn - Pulmonary
By DCH Health System At Northport, AL, United States
Requires use of electronic mail, time and attendance software, learning management software and intranet.
Provides clinical expertise, support and feedback to facilitate the advancement of clinical skills and evidence based practice.
Assists with planning clinical experiences for all new staff to the Department.
In collaboration with Clinical educator and manager, assigns new staff to appropriate preceptors.
Communicates routinely with department manager, preceptors and educator to assess ongoing needs and troubleshoot issues.
In conjunction with Clinical Education, assists with validation of annual staff competencies and other educational activities as needed.
Clinical Assistant Rn Jobs
By Central Maine Healthcare At , Topsham, 04086, Me
Graduate of an accredited school of nursing with up to six (6) months Registered Nurse experience.
Current American Heart Association Healthcare Provider BLS required. IV Certification preferred
Current RN license within the state of practice.
Ability to read and communicate effectively in English.
For physical demands of position, including vision, hearing, repetitive motion and environment, see following description.
Clinical Supervisor Rn Jobs
By Piedmont Healthcare At , Snellville, 30078, Ga

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW

Forbes named Piedmont one of Georgia’s 10 best employers and the highest-ranked healthcare provider.

Rn Clinical Analyst Jobs
By 6 Degrees Health Dx At Portland, OR, United States
Offer technical support by continuous assessment and feedback concerning data quality and proper encoding of services
Provide peer training and education on clinical review across the organization
Participate in continuing education to further understand industry billing practices and regulations
Strong internal and external communication skills, both verbal and written
Must be able to operate computers and phones to support position requirements
Strong Microsoft Office Skills are a must
Care Review Clinician, Inpatient Review (Rn) - Mississippi
By Molina Healthcare At , Starkville, Ms $26.41 - $51.49 an hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees:

Clinical Review Nurse I
By Elevance Health At Hingham, MA, United States
Medicare Part B Appeals experience preferred.
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider grievances and appeals.
Generates appropriate written correspondence to providers, members, and regulatory entities.
Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
Adapts to a wide variety of medical review topics in Part B appeals.
Clinical Review Nurse I
By Elevance Health At Atlanta, GA, United States
Medicare Part B Appeals experience preferred.
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider grievances and appeals.
Generates appropriate written correspondence to providers, members, and regulatory entities.
Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
Adapts to a wide variety of medical review topics in Part B appeals.