Utilization Review Nurse

Job DescriptionJob DescriptionJob Description:The Utilization Review Nurse’s role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing member treatment records, the utilization review nurse will ensure members do not receive unnecessary procedures, ineffective...

Job Description: The Utilization Review Nurse's role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing member treatment records, the utilization review nurse will ensure members do not receive unnecessary procedures, ineffective treatment, or experience...

Job Description:The Utilization Review Nurse's role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing member treatment records, the utilization review nurse will ensure members do not receive unnecessary procedures, ineffective treatment, or experience...

About the RoleWe are seeking a highly skilled and experienced Director of Utilization Review and Operations to join our team at Ridgeview Institute Smyrna. As a key member of our leadership team, you will be responsible for overseeing the Utilization Review Program and ensuring the provision of effective treatment plans for all patients.Key...

Are you a detail-oriented RN with a knack for navigating complex medical cases? Do you thrive on making critical decisions that impact patient care? Join us as a Care Management Coordinator and play a key role in evaluating and authorizing essential healthcare services. Shift: Monday – Friday (8am – 5pm Normal business hours) Type: Temp to...

Are you a detail-oriented RN with a knack for navigating complex medical cases? Do you thrive on making critical decisions that impact patient care? Join us as a Care Management Coordinator and play a key role in evaluating and authorizing essential healthcare services. Shift: Monday - Friday (8am - 5pm Normal business hours) Type: Temp to Hire...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.Position Purpose Performs concurrent reviews, including determining member's...

Job DescriptionJob DescriptionDescription:Are you passionate about making a difference? The World Trade Center (WTC) Health Program provides support to those impacted by 9/11. This position for a medical claims review nurse on the World Trade Center (WTC) Health Program will have a direct impact on members of the program. The nurse will be responsible for...

Position OverviewThe Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical records...

Job SummaryPiedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key ResponsibilitiesConduct detailed reviews of...

About the Role:Piedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed...

Job Summary:Piedmont is seeking a highly skilled Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed reviews of patient medical...

Position OverviewThe Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. Conduct review of facility and outpatient bills as it compares with medical records...

Position OverviewAre you dedicated to enhancing healthcare outcomes? KARNA LLC is seeking a skilled Medical Claims Review Nurse to contribute to our mission of supporting individuals affected by significant health events. This role is pivotal in ensuring that claims are meticulously reviewed for medical necessity and in addressing provider appeals...

Job Description:The Clinical Review Specialist role at Sonder Health Plans is to ensure that healthcare services are administered with quality, cost efficiency, and within compliance.By continuously reviewing and auditing member treatment records, the Clinical Review Specialist will ensure members do not receive unnecessary procedures, ineffective treatment,...

Position Overview: The role of the Healthcare Review Nurse is pivotal in ensuring that medical services are delivered with excellence, cost-effectiveness, and adherence to regulations. By systematically evaluating and auditing patient treatment records, the healthcare review nurse will prevent unnecessary procedures, ineffective treatments, and prolonged...

Position Overview: The role of the Healthcare Review Nurse is pivotal in ensuring that medical services are delivered with excellence, cost-effectiveness, and adherence to regulations. By systematically evaluating and auditing patient treatment records, the healthcare review nurse plays a crucial role in preventing unnecessary procedures, ineffective...

Job DescriptionJob DescriptionPOSITION SUMMARYThe Director of Utilization Review is responsible for overseeing the Utilization Review Program for In Patient and Outpatient services for this for-profit Behavioral Hospital. This includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective...

Position Overview: The role of the Healthcare Review Nurse is pivotal in ensuring that medical services are delivered with optimal quality, cost-effectiveness, and adherence to regulations. By systematically evaluating and auditing patient treatment records, the healthcare review nurse will safeguard against unnecessary procedures, ineffective treatments,...

Job Description:The Clinical Review Specialist role at Sonder Health Plans is to ensure that healthcare services are administered with quality, cost efficiency, and within compliance.By continuously reviewing and auditing member treatment records, the Clinical Review Specialist will ensure members do not receive unnecessary procedures, ineffective treatment,...