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Registered Nurse Clinical Reviewer Jobs

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.
Registered Nurse - Clinical Leader
By State University of New York Upstate Medical University At Syracuse, NY, United States

Job Summary: The Clinical Leader provides operations based support to the nursing unit and exemplifies the Upstate mission, vision, and values acting in accordance with Upstate policies and ...

Registered Nurse Clinical Nurse Labor & Delivery Ii N
By Wellstar Health System At , Marietta, 30060, Ga
National certification in area of specialty preferred.
Experience with direct patient care preferred.
Graduate of an accredited/approved school of nursing: Baccalaureate degree in nursing (BSN) from an accredited school of nursing preferred.
Current/active license as a registered nurse in the State of Georgia;
Must have a current BLS card from the American Heart Association on the first day of employment in position.
Registered Nurse (RN) - Labor and Delivery
Clinical Educator/Registered Nurse - Novasyte
By IQVIA At , Oklahoma City, Ok
Develop strong leadership and educator skills and interact with peers in the healthcare setting without patient care responsibilities
You are responsible for education only; no sales responsibilities, and no patient care.
Assess customer needs and assist with resolving issues stemming from lack of medical device knowledge or understanding of the particular product
Assist in the delivery of medical device-related in-service education to support key customers
Follow-up with key accounts and customers to assess unmet education and clinical needs as it relates to successful medical device implementation.
Serve as an education resource on the particular device
Coordinator Registered Nurse (Rn) Clinical Specialties I
By Kelsey-Seybold Clinic At , Houston, Tx $78,458 - $96,928 a year
Preferred: Specialty nursing certification appropriate to specialty area assigned. Windows- based computer skills.
Required: 2 years in a clinical area related to assigned department. Prior supervisory experience
Required: Current and valid BCLS from American Heart Association. Experience leading a team
Employee Reward and Recognition Program
Paid time off for vacation, sick, and holidays
Job Title: Coordinator Registered Nurse (RN) – SIGN ON BONUS – $5,000
Clinical Research Nurse (Registered Nurse)
By Indiana University At , Indianapolis, 46202, In
For full-time staff employees, Indiana University offers a wide array of benefits including:
3 years of nursing experience (with 1 year of outpatient nursing)
ACRP or SOCRA Clinical Research Certification upon date of hire
Strong verbal communication and listening skills
Tuition benefit for IU classes
Learn more about our benefits by reviewing our online Benefits Brochure.
Registered Nurse- Hro Clinical Navigator
By US Veterans Health Administration At , Ann Arbor, 48105, Mi $71,415 - $122,331 a year
If you are relying on your education to meet qualification requirements:
Works with QM, PSM, SR to identify vulnerabilities and develop processes and programs that advance safe, quality patient care.
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.
Preferred Experience in one of more of the following areas;
You will be evaluated for this job based on how well you meet the qualifications above.
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
Clinical Denials & Appeals Specialist (Registered Nurse) Remote
By Northwell Health At , Melville, 11747, Ny $78,000 - $130,000 a year

Remote Work Schedule: Sun-Thurs/8:30AM - 4:30PM

Registered Nurse | Clinical Care | Full Time
By DirectShifts At , New York, Ny $27 - $35 an hour
Partnering closely with Clinical and Operations team to consistently improve efficiency and customer experience for all appointments
Experience with phlebotomy, including Vitamin IV Treatments and Injections
Experience collecting and documenting vitals
Experience with EMR software required
Primary Responsibilities of an RN at Modern Age:
Setting up and monitoring customers during LED Therapy treatments
Registered Nurse (Clinical Educator)
By US Veterans Health Administration At , Cape Coral, Fl $65,332 - $126,060 a year
If you are relying on your education to meet qualification requirements:
Adult education experience - Preferred
Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
National Certification in applicable areas - Preferred
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.
Caregiver Support Registered Nurse Clinical Assessor
By US Veterans Health Administration At , San Diego, 92161, Ca $91,251 - $163,813 a year
If you are relying on your education to meet qualification requirements:
Advocates for Caregiver/Veteran dyads in ensuring availability of services and benefits for Caregivers and Veterans.
Completes comprehensive In-Home Assessments in accordance with program requirements. Maintains VISN directed, national and local safety requirements.
Provides consultation and education on Caregiver Support Program within the organization and to community Veterans and health care organizations.
Participates in development of educational tools and training to address specific caregiver needs and issues.
Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP)
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
Clinical Manager-Registered Nurse Jobs
By Plastic Surgery Group (Skin and Aesthetic Centers) At , Montclair, 07042, Nj
Train new staff and provide continuing education for current staff
Experience in Plastic Surgery/Aesthetics preferred
Comprehensive medical plan offerings with S&A contributing an average of 80% toward premiums.
Extensive ancillary benefits: dental, vision, voluntary life insurance, hospital indemnity, critical illness, EAP, and more!
Benefits of Joining Plastic Surgery Group/Skin & Aesthetic Centers
Operating Room cases and procedures (with Scheduler)
Registered Nurse | Clinical Care | Aesthetics
By DirectShifts At , New York, Ny $27 - $35 an hour
Partnering closely with Clinical and Operations team to consistently improve efficiency and customer experience for all appointments
Experience with phlebotomy, including Vitamin IV Treatments and Injections
Experience collecting and documenting vitals
Experience with EMR software required
Primary Responsibilities of an RN at Modern Age:
Setting up and monitoring customers during LED Therapy treatments
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

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