Utilization Review Nurse

Utilization Review Nurse for Workers' Comp Job Purpose: Review Workers Compensation requests submitted by the provider, requestor, claimant or carrier to determine the medical necessity of the treatment utilizing clinical expertise and evidence-based treatment guidelines. Duties: Perform an evaluation of the medical data for utilization review...

Job Title: Case Management Utilization Review RNThe Care Manager assumes primary responsibility for ensuring the medical necessity of inpatient status or placement in observation. They communicate effectively with physicians and clinicians, ensuring timely documentation and authorization of patient stays. Collaborating with other healthcare professionals,...

This is a contracted position that will start 01/02/2024 to 05/16/2025.Fully RemoteA RN or LPN/LVN responsible for annual patient chart inspection/audit. Audits are conducted to ensure that providers (MDs) accepting insurance are in compliance with standards of patient care set forth by the insurance company. Experience with medical record review...

Job Title: Prior Authorization Nurse Job Description The Prior Authorization Nurse is responsible for analyzing all prior authorization requests to determine the medical necessity of services and appropriate levels of care in accordance with national standards, contractual requirements, and member benefit coverage. The role involves providing...

Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse is responsible for analyzing all prior authorization requests to determine the medical necessity of services and appropriate levels of care in accordance with national standards, contractual requirements, and member benefit coverage. The role involves providing recommendations...

Neurologist Medical Review StreamLocation US-TX-DallasJob ID 300105Pos. Category Medical - Medical Review - URPos. Type ContractOverviewAre you an accomplished Board Certified Neurologist in one of the below specialties? Preferred candidates will have a TX license. Are you passionate about your work/life balance? We are seeking flexible and experienced...

Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse is responsible for analyzing all prior authorization requests to determine the medical necessity of services and appropriate levels of care in accordance with national standards, contractual requirements, and member benefit coverage. The role involves providing recommendations...

This is a contract position starting on January 6th, 2025 and going until April 30th, 2025 The position is fully remote. The pay is $40/hour for RN's. The pay is $37/hour for LPN/LVN. Review Nurse SUMMARY DESCRIPTION: The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information...

This is a contract position starting on January 6th, 2025 and going until April 30th, 2025The position is fully remote. The pay is $40/hour for RN's. The pay is $37/hour for LPN/LVN.Review NurseSUMMARY DESCRIPTION:The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set...

Location(s) Alpharetta, Georgia, Birmingham, Alabama, Charlotte, North Carolina, Dallas, Texas, Jacksonville, Florida, Lake Mary, Florida, McAllen, Texas, Miami, Florida, P&C-Butterfield Road-Downers Grove-IL-AAC Details Kemper is one of the nation’s leading specialized insurers. Our success is a direct reflection of the talented and diverse people who...

Key Responsibilities: Assist in implementation of project-specific safety and accident prevention programs and maintain safe work areas through regular job-site inspections Lead McCarthy's Task Hazard Analysis (THA) process and implement all safety and EEO/Affirmative Action programs Schedule and manage multiple crews performing various tasks across the...

Job DescriptionJob DescriptionDescription:Soleo Health is seeking a Healthcare Documentation Reviewer to support our Home Infusion Specialty Pharmacy Remotely (USA). Join us in Simplifying Complex Care! MA/LPN/Pharmacy Technician experience preferred, but not required. Soleo Health Perks:Competitive Wages401(k) with a MatchReferral BonusPaid Time OffGreat...

DDM Construction Corp. has been a leader in the Heavy Civil/Highway Infrastructure and Underground Utilities sectors for 29 years. We are a growing company that lives by the motto “building with integrity,” and we take pride in the quality and effort our employees bring to every project. As we continue to expand, we are dedicated to building teams of...

DDM Construction Corp. has been a leader in the Heavy Civil/Highway Infrastructure and Underground Utilities sectors for 29 years. We are a growing company that lives by the motto “building with integrity,” and we take pride in the quality and effort our employees bring to every project. As we continue to expand, we are dedicated to building teams of...

DDM Construction Corp. has been a leader in the Heavy Civil/Highway Infrastructure and Underground Utilities sectors for 29 years. We are a growing company that lives by the motto “building with integrity,” and we take pride in the quality and effort our employees bring to every project. As we continue to expand, we are dedicated to building teams of...

Job DescriptionMid-Senior Electrical Relay Engineer, Protection and Control Systems - Utility & RenewablesA developer and operator of high voltage transmission renewable energy systems is looking to grow its Engineering Operations Team with the addition of a Mid to Senior Level Transmission P&C Engineer. The role is based in Austin, TX (relocation assistance...

Overview Seeking a dynamic, innovative, collaborative professional who embraces commitment to superior service and quality. AmTrust Financial Services, an industry-leading insurance provider and top writer of workers' compensation insurance, has a need for a Quality Assurance Specialist in medical case management oversight for workers' compensation within...

Job Description Mid-Senior Electrical Relay Engineer, Protection and Control Systems - Utility & Renewables A developer and operator of high voltage transmission renewable energy systems is looking to grow its Engineering Operations Team with the addition of a Mid to Senior Level Transmission P&C Engineer. The role is based in Austin, TX (relocation...

Job Description: Quality Monitor Nurse II This position requires a current Texas Registered Nurse license (in good standing). Position may be filled statewide. This position is a mobile position. The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) division seeks a highly qualified candidate to fill the position of...

Location:Highland Springs by Erickson Senior Living Join our team as the Clinical Manager is an active member of the clinical leadership team who is responsible for the assessment, coordination, implementation, and evaluation of the delivery of safe and effective person-centered care in their assigned neighborhood. The Clinical Manager will also facilitate,...