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Registered Nurse Clinical Reviewer Jobs

Registered Nurse Clinical Supervisor
By Streamwood Behavioral Healthcare System At Streamwood, IL, United States

Are you looking for a rewarding career in Skilled Nursing? We are currently searching for a Registered Nurse Clinical Supervisor to join our friendly, caring and supportive team! We Offer Great ...

Clinical Qa Supervisor - Registered Nurse (Remote)
By Maximus At , Remote
Prepare weekly updates for QA Management regarding staff productivity
Knowledge of quality assurance, industry quality standards and auditing processes, training tools, research and analytical skills
Ability to successfully manage priorities; excellent organizational skills
Implement department/team goals identified by IPP QA Manager. Identify and set individual/team goals, supervise the completion of the goals
Manage the timecards, assignments, and time off requests of assigned staff
Ensure IPP QA staff maintain updated knowledge of policy and procedure changes
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
Registered Nurse Clinical Nurse Lead (Cnl) - Unit 700 Adult Surgical
By Tucson Medical Center At , Tucson, 85712

Sign-on bonus offered with 2 years of experience!

Part-Time Clinical Resource Registered Nurse (Crrn)
By Miles Community College At , Miles City, 59301
Maintains competency in clinical skills through continuing education and/or clinical practice.
Change Management - Communicates changes effectively.
Dependability - Follows instructions, responds to management direction; Takes responsibility
Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy
Offer input in the development, implementation, and evaluation of policies and curriculum for
Facilitates student learning in nursing skills lab through simulation and demonstration.
Clinical Informatics Registered Nurse
By Valley Children's Healthcare At , Madera, 93636 $48 - $73 an hour
Minimum 4 years clinical experience required
Minimum 3 years of experience and demonstrated competency with the current electronic documentation system required
Minimum 4 years experience in nursing informatics, information systems required
Epic Certification necessary to support area of specialty required within 90 days of hire or transfer into position
Clinical Informatics Certification (ANIA, CHCIO, RN-BC - Informatics Nursing Certification) preferred
Bachelor’s degree in nursing required
Registered Nurse (Rn) Clinical Compliance Specialist – Clinical Education
By Kelsey-Seybold Clinic At , Houston $95,098 - $117,478 a year
Employee Reward and Recognition Program
Paid time off for vacation, sick, and holidays
Job Title: Registered Nurse Clinical Compliance Specialist
Clinic Location: IBC Building Administration
Clinical Registered Nurse Jobs
By Institute on Aging At , San Francisco, 94118 $48 - $56 an hour
Manages minor illnesses, injuries, and the stable chronic illnesses of participants, according to standard procedures.
Preference will be given to those with experience in public health nursing, work with elders and/or acute care nursing.
At least two years of nursing experience at the RN level.
This range does not include any additional equity, benefits, or other non-monetary compensation which may be included.
Implements, directs, supervises and evaluates nursing care for participants of the IOA PACE program.
Participates in the health assessment and examination of applicants and participants; serves as a member of the Intake and Assessment Team.
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.
Clinical Care Reviewer, Pediatric Shift Care, Registered Nurse
By AmeriHealth Caritas At , Newtown Square, 19073, Pa
3+ years of Utilization Management experience, preferably within a managed care organization.
Experience utilizing evidence based clinical decision support tools, such as InterQual, desired.
Excellent communication, analytical, and critical thinking skills. Detail oriented and strong organizational skills.
Working knowledge of MS Office including Word, Excel, and Outlook, and Internet applications in Windows 10.
Current, active, and unrestricted Registered Nurse licensure in Pennsylvania.
Graduate from an accredited school of nursing. Bachelor's degree in Nursing preferred.
Registered Nurse-Clinical Educator Jobs
By US Veterans Health Administration At , Fort Harrison, 59636, Mt $76,777 - $136,863 a year
If you are relying on your education to meet qualification requirements:
Preventive Management of Disruptive Behavior (PMDB) program and function as the Program Coordinator.
Coordination and oversight of VHA nursing scholarship programs to assure they meet national timelines, documentation/evidence files, and reporting requirements.
Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required.
You will be evaluated for this job based on how well you meet the qualifications above.
Nurse Reviewer - Remote
By The Computer Merchant, LTD (TCM) At Anchorage, AK, United States

JOB TITLE:Nurse Reviewer - Remote

Registered Nurse - Clinical Nurse Liaison
By Intramed Plus At North Charleston, SC, United States
2+ years of nursing experience
Registered Nurse with a current license in the state of South Carolina
full-time Registered Nurse - Clinical Nurse Liaison
of $70K - to $80K/year
medical, dental, life insurance, a generous 401(k) plan, mileage reimbursement, short- and long-term disability, and quarterly bonuses
8-hour shifts, 5 days per week
Clinical Nurse Reviewer (Remote)
By Acentra Health At Harrisburg, PA, United States

Good Verbal And Written Communication Skills Essential.

Medical Record Abstracting Skills Required.

Registered Nurse Level 3 Grade 2 - Clinical Nurse Consultant
By Canberra Health Services At Potter, PA, United States
Develop and maintain liaison, consultation and education with other government and non-government agencies, families and carers.
Proven advanced clinical experience in a leadership role.
Strong organisational skills with a high degree of drive.
Minimum three years’ experience working in a Mental Health clinical role.
Holds or is working towards post-graduate qualification in Mental Health Nursing.
Recent 12-month experience working within a secured mental health setting.
Registered Nurse - Clinical Manager / Medicare Hh
By Optimum RTS, LLC. At Boynton Beach, FL, United States
Personnel Management experience of 2-3 years
Performs consistent 1:1 meeting with clinicians, providing monthly SHP scorecards and continued education
Contributes to the professional development and skill level of field clinicians and clinical assistants
Performs formal clinical evaluations with our clinicians to determine discharge or recertification appropriateness.
Medicare Home Health experience of 3-5 years
RN Clinical Manager, Medicare HH
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.

Are you a Registered Nurse looking for a new challenge? Join our team as a Clinical Reviewer and use your expertise to help improve patient care! As a Clinical Reviewer, you will be responsible for evaluating medical records, assessing patient care, and providing feedback to healthcare providers. Take the next step in your career and make a difference in the lives of patients!

Overview Registered Nurse Clinical Reviewers are responsible for reviewing medical records and other documents to ensure accuracy and compliance with regulations. They are responsible for providing feedback to healthcare providers and other stakeholders on the quality of care provided. They must be knowledgeable of medical terminology, coding, and regulatory requirements. Detailed Job Description Registered Nurse Clinical Reviewers are responsible for reviewing medical records and other documents to ensure accuracy and compliance with regulations. They must be knowledgeable of medical terminology, coding, and regulatory requirements. They must be able to interpret and analyze medical records and other documents to ensure accuracy and compliance with regulations. They must be able to provide feedback to healthcare providers and other stakeholders on the quality of care provided. They must be able to identify and address any discrepancies or errors in the medical records. They must be able to communicate effectively with healthcare providers and other stakeholders. Job Skills Required
• Knowledge of medical terminology, coding, and regulatory requirements
• Ability to interpret and analyze medical records and other documents
• Ability to provide feedback to healthcare providers and other stakeholders
• Ability to identify and address discrepancies or errors in medical records
• Ability to communicate effectively with healthcare providers and other stakeholders
• Ability to work independently and as part of a team
• Ability to prioritize tasks and manage time effectively
Job Qualifications
• Bachelor’s degree in Nursing or related field
• Current Registered Nurse (RN) license
• At least two years of experience in a clinical setting
• Knowledge of medical terminology, coding, and regulatory requirements
• Knowledge of medical record review and analysis
• Knowledge of quality improvement processes
• Excellent communication and interpersonal skills
• Strong organizational and problem-solving skills
Job Knowledge
• Knowledge of medical terminology, coding, and regulatory requirements
• Knowledge of medical record review and analysis
• Knowledge of quality improvement processes
• Knowledge of healthcare industry trends and best practices
Job Experience
• At least two years of experience in a clinical setting
• Experience in medical record review and analysis
• Experience in quality improvement processes
• Experience in providing feedback to healthcare providers and other stakeholders
Job Responsibilities
• Review medical records and other documents to ensure accuracy and compliance with regulations
• Interpret and analyze 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 and address discrepancies or errors in