Clinical Review Nurse Specialist

Job SummaryCorVel Corporation is seeking a highly skilled Clinical Review Specialist II to join our team. As a Clinical Review Specialist II, you will play a critical role in ensuring the medical necessity of in-patient admissions and out-patient treatment, while supporting the goals of our Case Management department.Key ResponsibilitiesConduct thorough...

Job SummaryWe are seeking a skilled Clinical Review Nurse to join our team at AmTrust Financial Services. As a Clinical Review Nurse, you will play a critical role in reviewing medical necessity, appropriateness, quality, and efficiency of services for Workers' Compensation claimants.Key ResponsibilitiesPerform utilization review activities prospectively,...

Job Title: Medical Review SpecialistConcentra is seeking a Medical Review Specialist to join our team. As a Medical Review Specialist, you will be responsible for reviewing medical files and providing recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family...

Job SummaryWe are seeking a highly skilled and experienced Medical Review Specialist to join our team at Concentra Career Choice. As a Medical Review Specialist, you will be responsible for reviewing medical files and providing recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, and return to work, short and...

Job SummaryUT Southwestern Medical Center is seeking a skilled Registered Nurse to join our Utilization Review team. As a Utilization Review Registered Nurse, you will play a critical role in ensuring that patients receive the most appropriate level of care, while also promoting efficient use of healthcare resources.Key ResponsibilitiesConduct medical...

Job SummaryWe are seeking a highly skilled Utilization Review Nurse to join our team at Elite. As a key member of our clinical review team, you will play a critical role in ensuring the medical necessity of treatment requests submitted by providers, requestors, claimants, or carriers.Key ResponsibilitiesMedical Necessity Review: Conduct thorough evaluations...

Job SummaryWe are seeking a highly skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will be responsible for conducting medical certification reviews to determine the medical necessity of acute care services.Key ResponsibilitiesConduct inpatient admission reviews for Medicare and Medicaid beneficiaries, as well...

Job SummaryUT Southwestern Medical Center is seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will conduct medical certification reviews for medical necessity for acute care facilities and services, using nationally recognized, evidence-based guidelines approved by medical staff to recommend level of...

Job Title: Clinical Nurse SpecialistAt Eberstein Witherite LLP, we are seeking a highly skilled Clinical Nurse Specialist to join our team. As a key member of our staff, you will play a vital role in providing exceptional patient care and support.Key Responsibilities:Assist in the implementation of clinical models and systems to ensure high-quality patient...

Job Title: Utilization Review NurseChildren's Health is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that our patients receive the most appropriate and effective care.Responsibilities:Conduct thorough reviews of patient records to determine medical necessity and...

HEDIS Review Nurse Job DescriptionThis is a contracted position that will involve remote work. As a Registered Nurse (RN) or Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) with an unrestricted license in the state, you will be responsible for annual patient chart inspection/audit. The audits are conducted to ensure that providers (MDs)...

About the RoleWe are seeking a highly skilled and experienced Pre-Service Review Coordinator to join our team at UnitedHealth Group. As a key member of our clinical review team, you will play a critical role in ensuring the medical appropriateness of pre-authorization requests.Key ResponsibilitiesReview and determine medical appropriateness of...

Job SummaryUT Southwestern Medical Center is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate level of care while minimizing unnecessary hospital stays.Key ResponsibilitiesConduct medical certification reviews for medical necessity...

Job Title: Utilization ReviewrnAt Children's Health, our mission is to Make Life Better for Children for 110 years, and generation to come. We recognize that their health plays a crucial role in achieving this goal.Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience,...

About VitalCaring GroupVitalCaring Group is a leading home health and hospice provider with a strong commitment to delivering exceptional quality care. Our team is dedicated to transforming lives and fostering hope through genuine caring.Job Title: Clinical Resource Specialist RNWe are seeking a highly skilled Clinical Resource Specialist RN to join our...

Job OverviewThis remote position allows for flexible scheduling and caseload management while adhering to client-required turnaround times. Reviewers are compensated on a per-case basis as independent contractors.Candidates must be a licensed Orthopedic Surgeon in Texas with experience in testimony, depositions, or counter affidavits. Access to a Texas...

Job Opportunity at Dane Street, LLCJob Title: Physician ReviewerJob Summary:Dane Street, LLC is seeking a highly skilled Physician Reviewer to join our team. As a Physician Reviewer, you will utilize your clinical expertise to review insurance appeals, prospective and retrospective claims, and provide an interpretation of the medical necessity of services...

About the RoleWe are seeking a highly skilled and experienced Clinical Nurse Specialist to join our team at CDI Health. As a Clinical Nurse Specialist, you will be responsible for overseeing the complete operation and performance of the delivery of dialysis treatment and care under the terms of the contract between CDI Health and the Skilled Nursing...

Job SummaryCleaver-Brooks Sales and Service, Inc. is seeking a highly skilled Contract Review Specialist to join our team. As a key member of our organization, you will be responsible for reviewing and analyzing various contracts and purchase orders to identify potential risks and ensure compliance with company policies.Key ResponsibilitiesContract Review...

About AbbottAbbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines.Our MissionWe're committed to advancing the treatment of heart...