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Clinical Review Nurse Jobs

Medical Review Nurse (Readmissions 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.
Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding.
Knowledge of insurance programs program, particularly the coverage and payment rules.
Excellent written and verbal communication skills.
Ability to manage multiple tasks including desk audits and claims review.
Minimum of three years diversified nursing experience providing direct care in an inpatient or outpatient setting.
Quality Review Nurse Specialist
By HHC At , Indianapolis, 46205, In
5 – 10 years of previous experience in long term care in a nursing management role.
Participates in the development of educational materials and staff training programs relative to long term care.
Participates in the compilation and completion of quarterly and other reports prepared for the HHC Board of Directors’ Planning Committee.
May attend HHC Planning Committee meetings as assigned to represent the Long Term Care Department or to present a special report.
Assists in the completion and follow up of any requests or directives resulting form the Planning Committee meetings as assigned.
Attends community and professional association functions and meetings representing HHC Long Term Care division as requested.
Medical Review Nurse Rn - Remote
By Florida Blue At , $64,800 - $81,000 a year
Experience with utilization management systems or clinical decision-making tools such as: Medical Coverage Guidelines (MCG), CMS guidelines, and/or InterQual
Review all requests not approved by the non-clinical support rep to determine benefit coverage and medical necessity
At least two (2) years clinical experience
Excellent written and verbal communication skills
Experience working with multiple research/processing systems
Experience working with MS Word, Excel, and PowerPoint
Clinical Review Nurse Jobs
By Novitas At , Jacksonville, Fl
Short- and long-term disability benefits
Excellent written and oral communication skills
Demonstrated experience with evaluating medical and health care delivery issues
Strong computer skills to include Microsoft Office proficiency
Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
401(k) plan with company match and immediate vesting
Manager Clinical Claim Review - Remote
By UnitedHealth Group At , Minnetonka, 55345, Mn $85,000 - $167,300 a year
Collaborate with physicians, claims operations, prior authorization, utilization management, local market teams and support staff as needed
Solid communication, presentation and writing skills
Solid knowledge of medical claims and medical necessity review processes
Intermediate experience using Microsoft Office applications (Word, Excel (pivot tables), PowerPoint)
Proven solid attention to detail and accuracy, excellent evaluative and analytical skills
2+ years of leadership experience
Clinical & Quality Compliance Review Nurse
By InHealth Management, LLC At , San Juan, Pr
It's fun to work in a company where people truly BELIEVE in what they're doing!
We're committed to bringing passion and customer focus to the business.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
Clinical Review Nurse Jobs
By Abbott Laboratories At , Kansas City, Mo
3-5 years’ minimum experience in Occupational health settings, hospital, and outpatient nursing
Career development with an international company where you can grow the career you dream of.
Free medical coverage for employees* via the Health Investment Plan (HIP) PPO
An excellent retirement savings plan with high employer contribution
Provide subject matter expertise in executing Drug Testing Services across Workplace Solutions broad customer base.
Interpret and report results of Workplace clients consistent with Workplace Solutions written Standard Operating Procedures.
Sj Clinical Nurse Ii
By University of Maryland Medical System At Towson, MD, United States
More than 12 months nursing experience. Solid knowledge and clinical skills.
Reports adverse events and near misses to appropriate management authority.
Must meet all unit specific certification requirements: (PALS, ACLS, NRP)
Competency in care of unit specific patient population; independently p and clinical skills; engaged in advancing own practice.
Contributes to developing/evaluating unit based orientation and other education activities.
Contributes to nursing support personnel skills and development.
Clinical Nurse Ii Jobs
By Albany Medical Center At Albany, NY, United States
Applies sound nursing judgment in patient care management decisions.
Orders, interprets, and evaluates diagnostic tests to identify and assess patients' conditions.
Assesses and evaluates patient needs for, and responses to, care rendered.
Provides primary and emergency care for occupational and non-occupational injuries and illnesses.
Administers over-the-counter and prescription medications as ordered.
Collaborates with the nursing team to create a Plan of Care for all patients.
Clinical Nurse Ii Jobs
By University of Maryland Medical System At Towson, MD, United States
More than 12 months nursing experience. Solid knowledge and clinical skills.
Competency in care of unit specific patient population; independently practices with solid knowledgeand clinical skills; engaged in advancing own practice.
Must meet all unit specific certification requirements: (PALS, ACLS, NRP)
Current AHA BLS certification required.
Serves as a clinical resource for others.
Applies and integrates evidence into practice
Clinical Review Specialist Jobs
By Accreditation Commission for Health Care (ACHC) At United States
Experience working with computer systems with proficient use of database and other office system programs.
Strong oral and written communication skills and presentation skills.
This position is 100% remote and can be located anywhere nationwide.
Review Summary of Findings (SOF) documentation submitted by Surveyors, ensuring accuracy.
Complete the Company Review Form and present the findings of the survey to the Accreditation Review Committee.
Participate as an active member of the Accreditation Review Committee.
Nurse Auditor Review 2 - Remote, Nationwide
By Humana At , Troy, 48083, Mi
This role will be performed 100% remotely/work at home.
CPT coding experience or certification
18 months of medical record or coding auditing experience
Ability to work independently and manage work load
Excellent writing, editing, interpersonal, planning, teamwork, and communications skills
Experience applying CMS manual, NCCI edits, LCD / NCD documentation to audits
Nurse Evaluator - Pre-Admission Screening And Resident Review - Temporary
By State of Vermont At , Waterbury, Vt $37.83 an hour

Nurse Evaluator - Pre-admission Screening and Resident Review - Temporary (Job Requisition #46541)

Bachelor of Science in Nursing (BSN).

Clinical Review Rn Jobs
By Centers Plan for Healthy Living At Margate, FL, United States
3-5 years of home care experience
Strong knowledge of OASIS and Medicare/Medicaid guidelines
OASIS and or Coding certification preferred
Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations.
Reviews Outcome Assessment Information Set (OASIS) and visit documentation for errors and inconsistencies related to clinical documentation, including wounds
Applies ICD-10-CM coding rules and regulations to the review process.
Imu Clinical Nurse Manager - The Woodlands, Tx
By Futurerecruit.net At The Woodlands, TX, United States
Certified in Basic Life Support; Professional certification in clinical area or management preferred
Collaborates with physicians, management team members, business partners, and customers to address strategic initiatives and organizational goals.
Previous experience in Critical Care Nursing &/or Leadership required
Title: IMU Clinical Nurse Manager
Participates in a systemic, interdisciplinary, and ongoing evaluation of programs, process improvement, desired client-centered outcomes, and organizational outcomes.
Adheres to all regulatory and Texas Board of Nursing standards.
Nurse Reviewer - Clinical Review Unit
By Hawaii Medical Service Association At , Kapolei, 96707, Hi
Two years clinical, case management or utilization management related experience
Document clinical case summary and review outcome of each review appropriately to meet regulatory and program requirements.
Call providers when additional clinical information is required to clarify or complete a complex precertification determination.
Approve precertification requests based on clinical judgment using criteria, medical record documentation and other information received from the provider.
Consult with Medical Directors on requests which do not meet clinical criteria and offer alternative covered health care options as appropriate.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
Clinical Nurse Iv Jobs
By WakeMed At , Raleigh, Nc

About WakeMed: Position Information: The Clinical Nurse is responsible for providing total comprehensive nursing to patients and their families through the implementation of a plan of care. The ...

Home Health Clinical Review Coordinator
By UnitedHealth Group At , Brentwood, 37027, Tn $32.60 - $63.99 an hour
2+ years of experience in utilization management role
Complete cross-training and maintain knowledge of multiple contracts/clients to support coverage needs across the business.
Perform other duties and responsibilities as required, assigned, or requested
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
More information can be downloaded at: http://uhg.hr/uhgbenefits
1+ years of experience working at a Medicare Certified home health agency
Clinical Quality Review Spececialist
By HCSC At , Chicago, Il
Knowledge of managed care processes.
Organizational skills and ability to meet deadlines and manage multiple priorities.
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.
Health claims and mainframe system experience.
Concurrent Review Nurse Jobs
By University HealthCare Alliance At , Newark, 94560, Ca $49.59 - $65.71 an hour
Excellent communication, organizational and time management skills with the ability to meet tight timeframes.
Refer members to various other departments (i.e., Case Management, Disease Management, TPL, COB) for follow-up as appropriate.
Properly request letters, including applying the appropriate legal and regulatory requirements for ICE and health plan specific letter Templates.
All other duties as assigned including department-specific functions and responsibilities:
Three (3) years of Medical/Surgical clinical nursing experience.
Proficient in Microsoft Office applications and other computer skills.

Are you a Clinical Review Nurse looking for a new challenge? Join our team and help us make a difference in the lives of our patients! We offer a competitive salary and benefits package, flexible hours, and a supportive team environment. Come join us and make a positive impact in the healthcare industry!

Overview:

A Clinical Review Nurse is a healthcare professional who is responsible for reviewing medical records and making decisions about the appropriateness of care provided to patients. They are responsible for ensuring that the care provided is in accordance with established standards of practice and that it is medically necessary. Clinical Review Nurses also provide guidance to healthcare providers on the most appropriate course of treatment for a patient.

Detailed Job Description:

Clinical Review Nurses are responsible for reviewing medical records to ensure that the care provided is medically necessary and in accordance with established standards of practice. They must be able to interpret medical records and make decisions about the appropriateness of care provided. Clinical Review Nurses must also be able to provide guidance to healthcare providers on the most appropriate course of treatment for a patient. They must be able to communicate effectively with healthcare providers and patients to ensure that the care provided is appropriate and meets the patient's needs.

What is Clinical Review Nurse Job Skills Required?

• Knowledge of medical terminology and anatomy
• Knowledge of medical coding and billing
• Knowledge of healthcare regulations and standards
• Ability to interpret medical records
• Ability to make decisions about the appropriateness of care provided
• Ability to provide guidance to healthcare providers
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team

What is Clinical Review Nurse Job Qualifications?

• Bachelor’s degree in Nursing or a related field
• Current Registered Nurse (RN) license
• Certification in Clinical Review Nursing (CCRN)
• Experience in a clinical setting
• Knowledge of medical coding and billing

What is Clinical Review Nurse Job Knowledge?

• Knowledge of medical terminology and anatomy
• Knowledge of healthcare regulations and standards
• Knowledge of medical coding and billing
• Knowledge of clinical review processes

What is Clinical Review Nurse Job Experience?

• Experience in a clinical setting
• Experience in medical coding and billing
• Experience in clinical review processes

What is Clinical Review Nurse Job Responsibilities?

• Review medical records to ensure that the care provided is medically necessary and in accordance with established standards of practice
• Interpret medical records and make decisions about the appropriateness of care provided
• Provide guidance to healthcare providers on the most appropriate course of treatment for a patient
• Communicate effectively with healthcare providers and patients to ensure that the care provided is appropriate and meets the patient's needs
• Monitor patient outcomes to ensure that the care provided is effective
• Maintain accurate records of all reviews and decisions made