Clinical Medical Review Nurse

Job Title: HEDIS Nurse/Clinical Medical Review NurseJob Summary:We are seeking a highly skilled Clinical Medical Review Nurse to join our team at Three Point Solution. As a Clinical Medical Review Nurse, you will be responsible for reviewing professional and institutional claims, as well as provider appeals, to determine their eligibility for benefits. You...

Job SummaryThree Point Solution is seeking a highly skilled Clinical Medical Review Nurse to join our team. As a Clinical Medical Review Nurse, you will be responsible for reviewing professional and institutional claims, analyzing medical information, and communicating the impact of information on medical policy.Key Responsibilities:Review and analyze...

Job Title: HEDIS Nurse/Clinical Medical Review NurseAt Three Point Solutions, we are seeking a highly skilled Clinical Medical Review Nurse to join our team. As a Clinical Medical Review Nurse, you will play a critical role in ensuring the accuracy and integrity of medical claims and appeals.Key Responsibilities:Receive, research, review, and analyze...

Job Title: Clinical Medical Review NurseWe are seeking a highly skilled and experienced Clinical Medical Review Nurse to join our team at Vega Consulting Solutions, Inc.Job Summary:The Clinical Medical Review Nurse will be responsible for conducting thorough medical record reviews to ensure accuracy and compliance with HEDIS guidelines. This role requires a...

We are seeking a skilled Clinical Medical Review Nurse to join our team at ICONMA. This role involves reviewing and analyzing professional and institutional claims using critical thinking and nursing clinical judgment.Responsibilities:35% Reviews and analyzes professional and institutional claims using critical thinking and nursing clinical judgment.25%...

Job Title: HEDIS NurseJob Summary:We are seeking a highly skilled HEDIS Nurse to join our team at Three Point Solutions. The successful candidate will be responsible for handling day-to-day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims...

Clinical Medical Review Nurse Job DescriptionWe are seeking a skilled Clinical Medical Review Nurse to join our team at ICONMA. As a key member of our Quality Team, you will play a crucial role in ensuring the accuracy and quality of our HEDIS data.Key Responsibilities:Conduct thorough HEDIS overreads in line with NCQA guidelines, accurately and efficiently...

Job Title: Clinical Medical Review NurseJob Summary:We are seeking a highly skilled Clinical Medical Review Nurse to join our Quality Team at Charter Global. The successful candidate will be responsible for conducting thorough HEDIS overreads, medical record retrieval, and research during the Medical Record Review Project.Key Responsibilities:Accurately and...

Job Title: HEDIS/Clinical Medical Review NurseJob Summary:Zolon Tech Inc. is seeking a skilled Clinical Medical Review Nurse to join our team. The successful candidate will be responsible for reviewing professional and institutional claims, as well as provider appeals, to determine eligibility for benefits and support claims processing and/or...

Job Title: Clinical Medical Review NurseWe are seeking a highly skilled and experienced Clinical Medical Review Nurse to join our team at Vega Consulting Solutions, Inc. As a key member of our Quality Department, you will play a crucial role in ensuring the accuracy and quality of our medical records and data.Key Responsibilities:Conduct thorough HEDIS...

Clinical Medical Review Nurse **Job Summary:** We are seeking a highly skilled Clinical Medical Review Nurse to join our team at Three Point Solutions. The successful candidate will be responsible for conducting HEDIS overreads, assisting with medical record retrieval, participating in internal audits, and supporting quality department needs. **Key...

Utilization Review Nurse (RN)Job Summary: We are seeking a skilled Utilization Review Nurse to join our team at LifeBridge Health. As a Utilization Review Nurse, you will play a critical role in ensuring the efficient use of healthcare resources while maintaining high-quality patient care.Key Responsibilities:Conduct concurrent and retrospective chart...

Job Title: Clinical Medical Review Nurse SpecialistJob Summary:We are seeking a Clinical Medical Review Nurse Specialist to support our HEDIS operations. The successful candidate will conduct thorough medical record reviews, identify and report abstraction errors, and provide measure re-education to abstractors.Key Responsibilities:Accurately and efficiently...

Job SummaryWe are seeking a skilled Clinical Medical Review Nurse to join our team at KMM Technologies, Inc. This role involves reviewing professional and institutional claims, as well as provider appeals, to determine eligibility for benefits and support claims processing and adjudication.Key ResponsibilitiesConduct in-depth reviews of medical claims and...

Job Summary:As a Clinical Medical Review Nurse at Zolon Tech Inc., you will play a crucial role in reviewing professional and institutional claims, as well as provider appeals, to determine their eligibility for benefits. This position requires a strong understanding of medical information and the ability to analyze complex data to support claims processing...

Job SummaryWe are seeking a skilled Clinical Utilization Review Nurse to join our team at Centurion Managed Care. The successful candidate will be responsible for reviewing requests for prior authorization of medical services, ensuring medical necessity and appropriate level of care.Key ResponsibilitiesPerform on-site and telephonic reviews of patient...

Job SummaryClinical Utilization Review Nurse needed for part-time position at Grace Medical Center. Conduct concurrent and retrospective chart review for clinical, financial and resource utilization information. Provide intervention and coordination to decrease avoidable delays and denial of payment.ResponsibilitiesConduct chart review for clinical,...

Job Summary:ALTA IT Services is seeking a Clinical HEDIS Specialist to support a leading health insurance customer. The successful candidate will conduct thorough HEDIS overreads in line with NCQA guidelines, ensuring accuracy and efficiency. Additional responsibilities include Medical Record Retrieval for HEDIS and Risk Adjustment, participating in internal...

Job SummaryClinical Utilization Review Specialist needed for part-time position at Grace Medical Center. Conduct concurrent and retrospective chart review for clinical, financial and resource utilization information. Provide intervention and coordination to decrease avoidable delays and denial of payment.ResponsibilitiesConduct chart review and abstract...

Job OverviewThree Point Solution is seeking a highly skilled Clinical Medical Review Nurse to join our team. As a key member of our Quality Team, you will be responsible for conducting HEDIS overreads, assisting with medical record retrieval, and participating in internal audits.Key Responsibilities:Conduct HEDIS overreads and correct errors to maintain...