Clinical Review Nurse

Purpose Contributes to the overall success of the Utilization Management department by performing clinical reviews for outpatient, including determining the member's overall health, reviewing the type of care being delivered, and evaluating medical necessity, in compliance with governing regulations, internal policies, and procedures. Accountabilities *...

Job SummaryWe are seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will be responsible for performing utilization review with payers, assisting physicians with level of care determinations, and coordinating patient care to ensure optimal outcomes.Key ResponsibilitiesPerform utilization review and payer...

Job Summary:Trinity Health is seeking a skilled Registered Nurse to fill the role of Clinical Utilization Review Specialist. This position will be responsible for performing utilization review with payers, assisting physicians with level of care determinations, and promoting improvements in work processes within the department, hospital, and community.Key...

Job DescriptionAt Trinity Health Of New England, we are seeking a skilled Clinical Utilization Review Specialist to join our team. As a key member of our healthcare team, you will be responsible for performing utilization review and payer notification, establishing partnerships with site BPCI RNs, and educating patients and families about financial...

Transforming Healthcare TogetherEvolent Health partners with health plans and providers to deliver better health outcomes for individuals with complex and costly health conditions. As a key member of our utilization management team, you will play a vital role in ensuring patients receive the same level of care and compassion we would want for our loved...

Summary The Clinical Documentation Improvement (CDI)/Utilization Review Manager will manage the day-to-day functions of both Programs to ensure their success across the organization. As the CDI Manager, they will ensure that the CDI Nurses are performing their clinical documentation validations timely and efficiently and in accordance with regulatory...

Overview: Shift: 12pm - 12am Performs clinical review of patient records to evaluate the utilization of acute care services. Communicates to third party payors to support the medical necessity of the hospital admission for services reimbursement. Ensures the patient care team is aware of general length of stay requirements for all patients. Facilitates...

Nurse Reviewer II Job SummaryThis position is responsible for coordinating and conducting various review activities as defined by HSAG's contract with the State of Hawaii, Department of Human Services MedQUEST Division (DHS/MQD).The Nurse Reviewer II will use professional judgment to apply established screening criteria to conduct long-term care level of...

Job Description:Job Title: Clinic Nurse Location: Springfield, MODepartment: Psychiatry ClinicsEmployment Type: Full-timeJob Summary: The Licensed Practical Nurse (LPN) is responsible for providing nursing services to patients in residential care facilities, behavioral health and/or substance use disorder treatment programs. They work to maintain a safe and...

The Surgery Center of New England is looking for a Clinical Nurse Supervisor to oversee our clinical staff and work collaboratively with the Center Administrator. The Clinical Nurse Supervisor puts out the monthly nursing schedule, maintains regular trainings and competencies for the clinical staff, serves as the Infection Control Coordinator and helps...

Job Description:Job Title: Clinic Nurse Location: Springfield, MODepartment: Psychiatry ClinicsEmployment Type: Full-timeJob Summary: The Licensed Practical Nurse (LPN) is responsible for providing nursing services to patients in residential care facilities, behavioral health and/or substance use disorder treatment programs. They work to maintain a safe and...

Job Description: Job Title: Clinic Nurse Location: Springfield, MO Department: Psychiatry Clinics Employment Type: Full-time Job Summary: The Licensed Practical Nurse (LPN) is responsible for providing nursing services to patients in residential care facilities, behavioral health and/or substance use disorder treatment programs. They work to maintain a safe...

Employment Type:Part timeShift:Rotating ShiftDescription:Requires BSNAt Mercy Medical Center the Utilization Review/Appeals & Denials RN performs utilization review with payers, assists the physician with level of care determinations using screening criteria, and assists the physician, bedside Registered Nurse, ICC and Social Worker with utilization...

Employment Type: Part time Shift: Rotating Shift Description: Requires BSN At Mercy Medical Center the Utilization Review/Appeals & Denials RN performs utilization review with payers, assists the physician with level of care determinations using screening criteria, and assists the physician, bedside Registered Nurse, ICC and Social Worker with...

**Employment Type:** Part time **Shift:** Rotating Shift **Description:** Requires BSN At **Mercy Medical Center** the **Utilization Review/Appeals & Denials** **RN** performs utilization review with payers, assists the physician with level of care determinations using screening criteria, and assists the physician, bedside Registered Nurse, ICC...

Job Description : The Clinical Instructor for the nursing program must meet the contractual job description as found in the MCCC Contract. Promote the philosophy and objectives of the School of Health & Patient Simulation (SHPS) and the College. Maintain the rules and regulations of the SHPS and the College. Foster and maintain College relationships within...

Job DescriptionEmployment TypePart timeShiftRotating ShiftDescriptionRequires BSNAt Mercy Medical Center the Utilization Review/Appeals & Denials RN performs utilization review with payers, assists the physician with level of care determinations using screening criteria, and assists the physician, bedside Registered Nurse, ICC and Social Worker with...

Job DescriptionEmployment TypePart timeShiftRotating ShiftDescriptionRequires BSNAt Mercy Medical Center the Utilization Review/Appeals & Denials RN performs utilization review with payers, assists the physician with level of care determinations using screening criteria, and assists the physician, bedside Registered Nurse, ICC and Social Worker with...

Clinical Nurse Supervisor Job DescriptionThe Surgery Center of New England is seeking a skilled Clinical Nurse Supervisor to oversee our clinical staff and collaborate with the Center Administrator. This full-time position involves overseeing the monthly nursing schedule, maintaining regular trainings and competencies for the clinical staff, serving as the...

Employment Type: Part time Shift: Rotating Shift Description: Requires BSN At Mercy Medical Center the Utilization Review/Appeals & Denials RN performs utilization review with payers, assists the physician with level of care determinations using screening criteria, and assists the physician, bedside Registered Nurse, ICC and Social Worker with utilization...