Clinical Review Nurse

2 weeks ago


Kansas City, United States Spectraforce Technologies Full time
Job Title: Clinical Review Nurse - Prior Authorization

Duration: 05 Months
(Possible extension)

Location: Remote - MO


Monday - Friday (8 hours)

Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD):
  • Reviewing authorization requests
  • Utilizing evidence-based criteria and making a medically necessary determination.
  • Outreach calls to providers to request additional details if applicable.
  • They will not be completing any calls to members.


Required Skills/Experience:

Preferred Skills/ Experience:

1.
ICU, Medical Surgical background, bedside experience (Home health nurses)
1.
Medicare experience ( Utilization Management with Medicare)

2.
Utilization Review (Prior Authorization)
2.
CCM Certification

3.
Acute Care
3.
ACLS Certification

Education Requirement:
Bachelor's with RN or RN without Bachelors is okay too
Education Preferred:

Software Skills Required:
TruCare is the system the team uses so if they have experience it is beneficial. Microsoft Office Systems

Required Certifications:
RN is what the team is really looking for (If the person has an RN license without a bachelors, they are okay)

LPN - Licensed Practical Nurse - State Licensure required Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria.
Required Testing:
n/a

  • Kansas City, Missouri, United States Actalent Full time

    Position Overview:We are seeking a dedicated Utilization Management Nurse to support a prominent health plan. This role offers a competitive hourly wage.Work Schedule:This position operates on a standard weekday schedule, ensuring a work-life balance.Key Responsibilities:Ensure compliance with all relevant State and Federal regulations, as well as internal...


  • Kansas City, Missouri, United States Alcanza Clinical Research Full time

    Job DescriptionAlcanza Clinical Research is a leading provider of clinical research services, with a strong presence across Phase I-IV studies and multiple therapeutic areas. We are seeking a highly skilled Clinical Research Coordinator to join our team.Key ResponsibilitiesUnder the direction of the Site Manager/Director and Principal/Sub Investigators,...


  • Olathe, Kansas, United States Springstone, Inc. Full time

    About the RoleCottonwood Springs, a leading behavioral health organization, is seeking a highly skilled Utilization Review Specialist to join our team. As a Utilization Review Specialist, you will play a critical role in advocating on behalf of our patients to managed care providers for necessary treatment.Key ResponsibilitiesAct as a liaison between managed...

  • Nurse Reviewer

    4 days ago


    Oklahoma City, Oklahoma, United States Gainwell Technologies LLC Full time

    About the RoleWe are seeking a skilled and experienced Nurse Reviewer to join our team at Gainwell Technologies LLC. As a key member of our clinical review team, you will play a critical role in ensuring the quality and accuracy of our medical record reviews.Key ResponsibilitiesConduct thorough and accurate reviews of medical records to determine the...


  • Kansas City, United States Everest Clinical Research Services Inc Full time

    Everest Clinical Research (“Everest”) is a full-service contract research organization (CRO) providing a broad range of expertise-based clinical research services to worldwide pharmaceutical, biotechnology, and medical device industries. We serve some of the best-known companies and work with many of the most advanced drugs, biologics, and medical...


  • Kansas City, Missouri, United States Everest Clinical Research Services Inc Full time

    Company Overview: Everest Clinical Research Services Inc. is a premier contract research organization (CRO) dedicated to delivering a comprehensive suite of expertise-driven clinical research solutions to global pharmaceutical, biotechnology, and medical device sectors. We collaborate with some of the most renowned companies and are involved with many of...


  • Kansas City, Missouri, United States Everest Clinical Research Services Inc Full time

    Company Overview: Everest Clinical Research Services Inc. is a comprehensive contract research organization (CRO) offering a wide array of expertise-driven clinical research solutions to global pharmaceutical, biotechnology, and medical device sectors. We collaborate with some of the most reputable companies and engage with many of the most innovative...

  • Registered Nurse

    2 weeks ago


    Kansas City, Missouri, United States Voca Full time

    Voca is currently seeking a travel nurse RN specializing in Utilization Review for an exciting opportunity. Position Overview & Requirements Specialty: Utilization Review Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel As a Voca Traveler, you will have the chance to enhance your clinical...


  • Kansas City, Missouri, United States Everest Clinical Research Services Inc Full time

    Company Overview: Everest Clinical Research Services Inc. is a premier contract research organization (CRO) delivering a comprehensive suite of expertise-driven clinical research solutions to global pharmaceutical, biotechnology, and medical device sectors. We collaborate with some of the most recognized companies and engage with numerous advanced...


  • Kansas City, United States Alcanza Clinical Research Full time

    Job DescriptionJob DescriptionDescriptionAlcanza is a growing multi-site, multi-phase clinical research company with a network of locations in MA, NH, MI, VA, SC, FL, GA, AL, MO, TX and Puerto Rico. We have established a strong presence across Phase I-IV studies and several therapeutic areas including vaccine, neurology, dermatology, psychiatry, and general...


  • Kansas City, Missouri, United States The University of Kansas Health System Full time

    Job SummaryThe Ambulatory Clinic LPN is a vital member of our healthcare team, responsible for providing high-quality patient care in a fast-paced ambulatory setting. As a Licensed Practical Nurse (LPN), you will utilize the nursing process to coordinate an interdisciplinary approach to patient care, promoting and restoring patients' health through physical...


  • Kansas City, Kansas, United States The University of Kansas Health System Full time

    Job SummaryWe are seeking a highly skilled and compassionate Registered Nurse to join our team at The University of Kansas Health System. As an Ambulatory Clinic Nurse, you will play a vital role in providing high-quality patient care in a fast-paced and dynamic environment.Key ResponsibilitiesProvide direct patient care in the ambulatory setting, utilizing...


  • Kansas City, Missouri, United States Elevance Health Full time

    Job Overview Position: Manager of Utilization Review Location: This role operates in a hybrid model, combining remote work with office presence. Candidates must reside within a specified commuting distance of an Elevance Health facility. The Manager of Utilization Review plays a pivotal role in supervising a team of healthcare professionals...


  • Kansas City, Missouri, United States Versa Recruiting, LLC Full time

    Position OverviewROLE: Clinical Nurse Specialist - Surgical Care UnitEMPLOYMENT STATUS: Full-Time OpportunitySIGN-ON INCENTIVE: $30,000 for night shift positions (requires a two-year commitment)KEY RESPONSIBILITIES: Ensure accountability for the care of designated patients Oversee the continuum of patient care, including assessment, preparation,...


  • Kansas City, Missouri, United States The University of Kansas Health System Full time

    Job SummaryThe University of Kansas Health System is seeking a skilled Ambulatory Clinic Registered Nurse to join our team. As an Ambulatory Clinic RN, you will be responsible for providing high-quality patient care in an outpatient setting.Key ResponsibilitiesProvide direct patient care in an ambulatory setting, utilizing the nursing process and adhering to...


  • Kansas City, Kansas, United States Kansas City Kansas Community College Full time

    Position Title: Clinical InstructorCompensation: $63.44 per scheduled student contact hour. Simulation and checkoffs are compensated at $46.73 per scheduled student contact hour.Employee Category: FacultyPosition Type: Adjunct Faculty/POOLFLSA Status: ExemptPosition Details:Job Code: AA004Department: Nursing DivisionReports to: Dean of Health...


  • Kansas City, Missouri, United States The University of Kansas Health System Full time

    Job SummaryThe University of Kansas Health System is seeking a skilled Clinical Nurse Educator to join our team. As a Clinical Nurse Educator, you will play a vital role in ensuring the delivery of high-quality patient care by collaborating with the healthcare team to develop and implement evidence-based practices.Key ResponsibilitiesCollaborate with the...


  • Kansas City, United States The University of Kansas Health System Full time

    Position TitleRadiation Oncology Clinic - Clinical Nurse Coordinator FloatDays - Part TimeBloch Radiation Oncology PavilionPosition Summary / Career Interest:The Ambulatory Clinic RN Care Coordinator is a licensed registered professional nurse who is a clinical expert who provides ethical, evidence-based, safe and compassionate nursing care. The Ambulatory...


  • Kansas City, Kansas, United States The University of Kansas Hospital Full time

    Job SummaryThe University of Kansas Hospital is seeking a highly skilled Ambulatory Clinic Registered Nurse to join our team. As a key member of our healthcare team, you will provide exceptional patient care and support to our patients and families.Key ResponsibilitiesProvide direct patient care within the ambulatory setting, utilizing the nursing process...


  • Kansas City, Missouri, United States The University of Kansas Health System Full time

    Job SummaryThe University of Kansas Health System is seeking a highly skilled Ambulatory Clinic Registered Nurse to join our team. As an Ambulatory Clinic RN, you will be responsible for providing high-quality patient care in a fast-paced ambulatory setting.Key ResponsibilitiesProvide direct patient care within the ambulatory setting, utilizing the nursing...