Remote Clinical Review Nurse – Prior Authorization Location: Must be located in Central or Eastern time zones... all review decisions clearly, accurately, and in compliance with regulatory and organizational standards. Maintain up...
management, discharge planning or utilization review experience. Licenses/Certifications: RN - Registered Nurse - State.... We are in search of a highly motivated candidate to join our talented Team. Job Title: Clinical Medical Review Nurse. Location...
plan clinical operations (for example utilization review, quality improvement, clinical claims review). Experience...JOB SUMMARY: The Medical Review Examiner Nurse is responsible for auditing provider and facility claims. Identifying...
. Settings include inpatient, outpatient, in-state, out-of state and out-of country. Document clinical case summary and review... outcome of each review appropriately to meet regulatory and program requirements. Review various types of services, including...
including utilization review and case management functions. Ensure compliance of MPN with our business partner, design, develop... of the position will be to differentiate the PRIME program in the marketplace; manage bill review and the nurse case managers...
managers including utilization review and case management functions. Ensure compliance of MPN with our business partner, design... functions of the position will be to differentiate the PRIME program in the marketplace; manage bill review and the nurse case...
Job Description: This position will be remote role for Nurses in Michigan Should have a valid MI RN License... Should Have utilization management experience. Should have experience completing post-acute reviews for the inpatient rehab, skilled nursing...
, interdisciplinary rounds, and patient/family education Collaborates effectively with the utilization review nurse, patient's physicians... discharge planning Day shift supplemental PRN as needed The Care Coordinator RN Sr. (RN Sr) is responsible for assessing...
(United States of America) Overview The RN Clinical Nurse is a proactive member of an interdisciplinary team of licensed... Practice Model and evidence-based practice and research. RN competencies are derived from these models and supported by the...
with all data collections and auditing activities. Accountable for completion of the Annual Standing Order Review and Internal... Classification of Disease (ICD) coding. Manages clinic financials including efficient utilization of supplies or equipment...
and planning, coordination of care, resource utilization management and/ or review, discharge planning, documentation... care experience in a Medical Surgical or Inpatient setting IRR or annual competency testing in Utilization Review...
’s plan of care and review on an ongoing basis Provide ongoing coaching to drive effective utilization of established... What You Will Bring: Must hold an active Registered Nurse (RN) License and/or be a Licensed Social Worker (LSW/LISW) in the state...
/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience...: Current unrestricted license to practice as a Registered Nurse (RN) in the state associated with this position · Current CPR...
/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience...: Current unrestricted license to practice as a Registered Nurse (RN) in the state associated with this position · Current CPR...
Service, Teamwork, Resource Utilization, and Staff and Self Development as outlined in performance review. 11. Performs... what we do, as individuals and professionals, every day. Reporting to the PCS Manager / Clinical Coordinator, the Registered Nurse (RN...
more below. Summary: The RN Case Manager coordinates the care and service of patient populations from admission through discharge. The... RN Case Manager, collaboratively with inter-disciplinary teams, works to build a comprehensive case management plan...
caring for children with medical complexity. Current or previous hospital case management or utilization review experience.... Current or previous case management or utilization review leadership experience. For MSW Manager: Required Education...
Description The Staff RN uses the nursing process to deliver nursing care to a given patient care population as it... of treatment utilizing established procedures standards and protocols of individuals within the assigned work shift. The Staff RN...
work settings. The Registered Nurse RN Prior Authorization Medical Management Services is required to be technologically..., Optum360 Encoder Pro, (a provider lookup tool for contracted and noncontracted status,) and more. The RN Prior Authorization...
(CCM) Case management experience Experience in discharge planning Experience in utilization review, concurrent review... as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted RN...