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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.
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.
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

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
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
Nurse Reviewer I-9 Jobs
By Elevance Health At Illinois, United States
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred.
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network.
Notifies ordering physician or rendering service provider office of the preauthorization determination decision.
Nurse Reviewer I-9 Jobs
By Elevance Health At Rhode Island, United States
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred.
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network.
Notifies ordering physician or rendering service provider office of the preauthorization determination decision.
Nurse Reviewer I-9 Jobs
By Elevance Health At Florida, United States
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred.
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network.
Notifies ordering physician or rendering service provider office of the preauthorization determination decision.
Nurse Reviewer I-9 Jobs
By Elevance Health At United States
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred.
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network.
Notifies ordering physician or rendering service provider office of the preauthorization determination decision.
Professional Reviewer - Nurse Anesthetists (Crna) - Remote
By Michigan Peer Review Organization At , Remote
Use your clinical knowledge to improve the quality of health care.
Enjoy the convenience of reviewing cases remotely.
Must have a minimum of three years of clinical experience in your specialty.
Join a pool of professionals who are experts in their specialties.
Protect the integrity of your medical specialty.
Provide final determinations regarding medical necessity and quality of care issues.
Nurse Reviewer I Jobs
By Elevance Health At , Deerfield, Il
Previous utilization and/or quality management and/or call center experience preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Candidates must have good computer skills and solid typing speed and accuracy.
Nurse Reviewer I Preferred Qualifications:
Nurse Reviewer (Level I) Soft Skills:
Job Family: Medical and Clinical
Nurse Reviewer I Jobs
By Elevance Health At , Cerritos, 90703, Ca
Previous utilization and/or quality management and/or call center experience preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Candidates must have good computer skills and solid typing speed and accuracy.
Nurse Reviewer I Preferred Qualifications:
Nurse Reviewer (Level I) Soft Skills:
Job Family: Medical and Clinical
Nurse Reviewer I Jobs
By Elevance Health At Illinois, United States
Previous utilization and/or quality management and/or call center experience preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Candidates must have good computer skills and solid typing speed and accuracy.
Job Family: Medical and Clinical
Receives pre-authorization requests from front-line intake
Conducts initial medical necessity clinical screening
Nurse Reviewer (Associate Or Level I)
By Elevance Health At Grand Prairie, TX, United States
Quality management and/or call center experience is a plus
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Customer service experience is preferred.
Any experience in clinical nursing experience is a plus
Nurse Reviewer (Associate Or Level I)
By Elevance Health At Illinois, United States
Quality management and/or call center experience is a plus
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Customer service experience is preferred.
Any experience in clinical nursing experience is a plus
Nurse Reviewer (Associate Or Level I)
By Elevance Health At Wixom, MI, United States
Quality management and/or call center experience is a plus
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Customer service experience is preferred.
Any experience in clinical nursing experience is a plus

Are you looking for a rewarding career in healthcare? Become a Nurse Reviewer and make a difference in the lives of patients and their families! As a Nurse Reviewer, you will have the opportunity to review medical records and provide quality assurance for healthcare services. You will be part of a team that is dedicated to providing the highest quality of care to patients. Join us and make a difference today!

Overview Nurse Reviewers are responsible for reviewing medical records and other documents to ensure accuracy and compliance with regulations. They are also responsible for providing feedback to healthcare providers and other stakeholders on the quality of care provided. Detailed Job Description Nurse Reviewers are responsible for reviewing medical records and other documents to ensure accuracy and compliance with regulations. They must be familiar with the relevant laws, regulations, and standards of care. They must also be able to interpret medical records and other documents to identify potential errors or discrepancies. Nurse Reviewers must be able to provide feedback to healthcare providers and other stakeholders on the quality of care provided. They must also be able to identify areas of improvement and recommend changes to ensure compliance with regulations. Nurse Reviewer Job Skills Required
• Knowledge of relevant laws, regulations, and standards of care
• Ability to interpret medical records and other documents
• Ability to provide feedback to healthcare providers and other stakeholders
• Ability to identify areas of improvement and recommend changes
• Excellent communication and interpersonal skills
• Attention to detail
• Analytical and problem-solving skills
• Computer literacy
Nurse Reviewer Job Qualifications
• Bachelor’s degree in Nursing or a related field
• Current nursing license
• Experience in medical record review
• Knowledge of relevant laws, regulations, and standards of care
• Ability to interpret medical records and other documents
Nurse Reviewer Job Knowledge
• Knowledge of relevant laws, regulations, and standards of care
• Knowledge of medical terminology
• Knowledge of medical record review
• Knowledge of healthcare systems and processes
Nurse Reviewer Job Experience
• Experience in medical record review
• Experience in providing feedback to healthcare providers and other stakeholders
• Experience in identifying areas of improvement and recommending changes
Nurse Reviewer Job Responsibilities
• Review medical records and other documents to ensure accuracy and compliance with regulations
• Provide feedback to healthcare providers and other stakeholders on the quality of care provided
• Identify areas of improvement and recommend changes to ensure compliance with regulations
• Monitor and evaluate the effectiveness of changes implemented
• Maintain accurate records of reviews and feedback
• Communicate with healthcare providers and other stakeholders to ensure compliance with regulations