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Nurse Case Reviewer Jobs

Nurse Case Manager Jobs
By Sentara Healthcare At , Norfolk, 23502
Experience in Commerical Managed Care
Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans
Minimum 3 years experience working as a Registered Nurse
Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible
Sentara Health Plans is currently hiring an Integrated Nurse Case Manager!
This is a Full Time position with Day shift hours and great benefits!
Case Management - Nurse, Consultant
By Blue Shield of California At , Long Beach $109,120 - $163,680 a year
Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
Assumes supervisor day to day responsibilities in manager’s absence and under the direction of the manager
A minimum of 3+ year experience in inpatient, outpatient or managed care environment required
Health insurance/managed care experience desired.
Requires at least 7 years of prior experience in nursing, healthcare or related field
Transitions of care experience desired
Case Management - Nurse, Senior
By Blue Shield of California At , Rancho Cordova, 95670 $85,360 - $128,040 a year
Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD)
Requires at least 5 years of prior experience in nursing, healthcare or related field
Extensive knowledge of evidenced based clinical practice guidelines particularly for chronic conditions.
Knowledge of Coordination of Care, Medicare regulations, prior authorization, level of care and length of stay criteria sets desirable.
Design appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomes
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
Nurse Case Coordinator Jobs
By NYU Langone At , New York, 10016 $88,979 - $126,399 a year
Care Coordination and Case Management for WTC responders
Assess active members for case-management service needs as clinically indicated
Develops Intensive case management Plan of Care and necessary follow-ups
Coordination with case management for post-discharge outreach
Address the unique health care needs of individual members and improve member satisfaction with the Program
Review of authorizations for medical necessity (prior authorization/prospective reviews and retrospective authorizations) as related to member’s WTC certified condition(s)
Nurse Case Manager Jobs
By Avalon Case Management At , Remote

fax a resume to 1-877-287-4890.

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.
Case Management - Nurse, Senior
By Blue Shield of California At , $85,360 - $128,040 a year
Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
Provides Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD).
A minimum of 1 year experience in inpatient, outpatient or managed care environment required
Health insurance/managed care experience desired.
Requires at least 5 years of prior experience in nursing, healthcare or related field
Transitions of care experience desired
Nurse Case Mgr Jobs
By Sentara Healthcare At , Norfolk, 23502
Keywords: nursing, discharge planning, managed care, case management, RN, nurse, health plan, health care, Indeed, Monster
Nursing experience 3 years required
Sentara Health Plans is currently seeking a full-time, Nurse Case Manager
Associates or Bachelor’s Degree in Nursing
Registered Nurse License (RN) - Virginia
Registered Nurse License (RN) - Compact/Multi-State License
Sr Nurse Case Analyst (Remote)
By CSX At ,
Knowledge of FRA Conductor and Engineer certification requirements
Review medical qualification of new hires, job transfers and certification examinations
Miscellaneous activities and responsibilities as assigned by manager
Knowledge of FRA drug testing requirements
Knowledge of Commercial Driver's License (CDL) medical requirements
3 or more years of work experience in the medical field
Sr Nurse Case Analyst (Remote)
By CSX At United States
Knowledge of FRA Conductor and Engineer certification requirements
Review medical qualification of new hires, job transfers and certification examinations
Miscellaneous activities and responsibilities as assigned by manager
Knowledge of FRA drug testing requirements
Knowledge of Commercial Driver's License (CDL) medical requirements
3 or more years of work experience in the medical field
Nurse (Case Manager) Jobs
By US Military Treatment Facilities under DHA At , Camp Pendleton, Ca $123,168 - $156,423 a year
See Qualifications section for education requirements.
If you are relying on your education to meet qualification requirements:
Identify and execute specific case management and care coordination activities.
Basic Requirement for Nurse (Case Manager):
Applicants must be able to fulfill non-privileged professional credential requirements.
Male applicants born after December 31, 1959 must complete a Pre-Employment Certification Statement for Selective Service Registration.
Nurse Case Manager/Ukhc
By University of Kentucky At , Lexington, Ky $54,080 - $95,056 a year
Skills / Knowledge / Abilities
Nurse Case Manager - ELIGIBLE FOR RECRUITMENT BONUS
Does this position have supervisory responsibilities?
A minimum of three years of experience providing patient care as a BSN, RN.
Click here for more information about equivalencies:
Monday through Friday, (8:00 am – 4:30 pm); occasional weekends and/or holidays required.
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.
Nurse Reviewer - Remote
By The Computer Merchant, LTD (TCM) At Anchorage, AK, United States

JOB TITLE:Nurse Reviewer - Remote

Nurse Case Manager I
By Elevance Health At Madison, WI, United States
Preferred Skills, Capabilities, And Experiences
Monitors and evaluates the effectiveness of the care management plan and modifies as necessary.
Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
Certification as a Case Manager is preferred.
Implements care plan by facilitating authorizations/referrals as appropriate within the benefits structure or through extra-contractual arrangements.
Job Family: Medical and Clinical
Nurse Case Mgr Ii
By Elevance Health At Phoenix, AZ, United States
Preferred Skills, Capabilities, And Experiences
Monitors and evaluates the effectiveness of the care management plan and modifies, as necessary.
Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
Assists with the development of utilization/care management policies and procedures.
Certification as a Case Manager is preferred.
Prior managed care experience is strongly preferred.
Nurse Case Manager Jobs
By Actalent At Happy Valley, OR, United States
This position is remote* Must sit within 50 miles of Portland
Maintaining an inclusive environment through persistent self-reflection
Building a culture of care, engagement, and recognition with clear outcomes
Ensuring growth opportunities for our people
DE&I Are Embedded Into Our Culture Through
Nurse Case Manager Jobs
By Actalent At Beaverton, OR, United States
Maintaining an inclusive environment through persistent self-reflection
Building a culture of care, engagement, and recognition with clear outcomes
Ensuring growth opportunities for our people
DE&I Are Embedded Into Our Culture Through
Field Nurse Case Manager
By EagleOne Case Management Solutions At Anaheim, CA, United States
Previous case management experience a plus
Understands and demonstrates the ability to apply Eagle One™ case management protocols
Utilizes appropriate cost management programs per account or company protocol (i.e., Pharmacy, DME, etc.)
Consults with Manager on case strategy as needed
Carbon copies the Manager on any documentation relating to initial assignment, claim barriers/complex cases or any case resolution issues
Alerts Manager of any requests to deviate from Eagle One™ or account specific protocols and obtains approval to proceed as necessary

Are you looking for a rewarding career in healthcare? Become a Nurse Case Reviewer and help improve the quality of care for patients! As a Nurse Case Reviewer, you will be responsible for reviewing medical records and making decisions about the care of patients. You will have the opportunity to work with a variety of healthcare professionals and make a real difference in the lives of patients. Join us today and make a positive impact on healthcare!

Overview:

A Nurse Case Reviewer is a professional nurse who is responsible for reviewing medical cases and making decisions regarding patient care. They are responsible for assessing the medical needs of patients and making decisions based on their findings. They also provide guidance and support to other healthcare professionals in the delivery of patient care.

Detailed Job Description:

Nurse Case Reviewers are responsible for reviewing medical cases and making decisions regarding patient care. They must assess the medical needs of patients and make decisions based on their findings. They must also provide guidance and support to other healthcare professionals in the delivery of patient care. They must be knowledgeable in medical terminology, anatomy, physiology, pharmacology, and disease processes. They must be able to interpret medical records and laboratory results. They must also be able to communicate effectively with other healthcare professionals and patients.

What is Nurse Case Reviewer Job Skills Required?

• Knowledge of medical terminology, anatomy, physiology, pharmacology, and disease processes
• Ability to interpret medical records and laboratory results
• Ability to communicate effectively with other healthcare professionals and patients
• Ability to make decisions based on patient needs
• Ability to provide guidance and support to other healthcare professionals
• Ability to work independently and as part of a team

What is Nurse Case Reviewer Job Qualifications?

• Bachelor’s degree in Nursing or related field
• Current Registered Nurse (RN) license
• Experience in medical case review
• Knowledge of medical terminology, anatomy, physiology, pharmacology, and disease processes
• Ability to interpret medical records and laboratory results

What is Nurse Case Reviewer Job Knowledge?

• Knowledge of medical terminology, anatomy, physiology, pharmacology, and disease processes
• Knowledge of medical case review
• Knowledge of patient care and treatment
• Knowledge of healthcare regulations and standards

What is Nurse Case Reviewer Job Experience?

• Previous experience in medical case review
• Previous experience in patient care and treatment
• Previous experience in healthcare regulations and standards

What is Nurse Case Reviewer Job Responsibilities?

• Review medical cases and make decisions regarding patient care
• Assess the medical needs of patients and make decisions based on their findings
• Provide guidance and support to other healthcare professionals in the delivery of patient care
• Interpret medical records and laboratory results
• Communicate effectively with other healthcare professionals and patients
• Monitor patient progress and provide updates to healthcare team