Clinical Review Nurse Specialist
4 weeks ago
We are seeking a highly skilled Clinical Review Nurse to join our team at Novitas Solutions. As a Clinical Review Nurse, you will play a critical role in reviewing and making medical determinations on health claims to ensure compliance with national and local policies, as well as accepted medical standards of care.
Key Responsibilities- Review and analyze pre and post-pay complex healthcare claims from a medical perspective
- Conduct clinical review work as assigned, providing guidance to other team members and accurately interpreting and applying broad CMS guidelines to specific situations
- Identify providers needing education and individually educate providers who are subject to medical review processes
- Participate in special projects as assigned
- High School Diploma or GED
- 2 years' clinical experience
- Excellent written and oral communication skills
- Demonstrated experience with evaluating medical and healthcare delivery issues
- Strong computer skills to include Microsoft Office proficiency
- Valid unrestricted Registered Nurse (RN) license
- Bachelor of Science in Nursing (BSN)
- Insurance industry experience
This opportunity is open to remote work in the following approved states: AL, AK, FL, GA, ID, IN, IO, KS, KY, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require further approval.
We are an Equal Opportunity Employer/Protected Veteran/Disabled.
-
Clinical Review Nurse Specialist
4 weeks ago
Mechanicsburg, Pennsylvania, United States Novitas Solutions Full timeJob SummaryThe Clinical Review Nurse is a critical role in ensuring the accuracy and integrity of healthcare claims. As a Clinical Review Nurse, you will be responsible for reviewing and making medical determinations on the validity of health claims and levels of payment.Key ResponsibilitiesReview and analyze pre and post-pay complex healthcare claims from a...
-
LPN Lead
2 weeks ago
Mechanicsburg, Pennsylvania, United States UPMC Full timeLPN Lead - Endocrinology SpecialistUPMC is seeking a skilled LPN Lead to join our Endocrinology team in Lemoyne. This full-time, day shift position offers a unique opportunity to lead a team of healthcare professionals and provide exceptional patient care.Key Responsibilities:Lead the Diabetes clinic flow team and provide professional nursing care to office...
-
LPN Lead for Endocrinology Clinic
2 days ago
Mechanicsburg, Pennsylvania, United States UPMC Full timeJob Title: LPN Lead for Endocrinology ClinicUPMC is seeking a highly skilled and experienced LPN Lead to join our Endocrinology team in Lemoyne. This is a full-time, day shift position with no weekends or holidays.Job Summary:The LPN Lead will provide professional nursing care to office patients under the supervision of patient care providers. The successful...
-
Behavior Consultant
3 weeks ago
Mechanicsburg, Pennsylvania, United States Laurel Life Full timeJob Title: Behavior Consultant - ABA SpecialistLaurel Life is seeking a highly skilled Behavior Consultant - ABA Specialist to join our Community Wellness team. As a key member of our team, you will have the opportunity to collaborate with our growing practice of Psychiatric CRNP's and over 20 licensed outpatient therapists specializing in trauma-informed...
-
Clinical Liaison Specialist
7 days ago
Mechanicsburg, Pennsylvania, United States VibraLife Full timeOverviewVibraLife is seeking a skilled Clinical Liaison to play a key role in our team.ResponsibilitiesEstablish and maintain effective working relationships with referral sources, healthcare providers, and community partners.Develop and implement strategies to increase referrals and admissions to VibraLife facilities.Conduct thorough assessments of...
-
Clinical Pharmacist
3 weeks ago
Mechanicsburg, Pennsylvania, United States Benecard Services, Inc. Full timeJob SummaryWe are seeking a highly skilled Clinical Pharmacist to join our team at Benecard Services, Inc. As a Clinical Pharmacist, you will play a critical role in ensuring the safe and effective use of medications for our customers.Key ResponsibilitiesConduct Drug Utilization Reviews to ensure medications are appropriate and safe for useProvide clinical...
-
Clinical Liaison Specialist
3 days ago
Mechanicsburg, Pennsylvania, United States VibraLife Full timeOverviewVibra Healthcare is seeking a skilled Clinical Liaison to join our team. As a key member of our Business Department, you will play a vital role in building relationships with referral sources, obtaining referrals, and completing SNF assessments.ResponsibilitiesEstablish and maintain effective working relationships with assigned accounts and team...
-
Clinical Liaison Specialist
4 weeks ago
Mechanicsburg, Pennsylvania, United States VibraLife Full timeOverviewVibraLife is seeking a skilled Clinical Liaison to play a key role in our team.ResponsibilitiesDevelop and maintain effective relationships with referral sources, healthcare professionals, and community partners.Conduct thorough assessments and screenings to determine patient eligibility for VibraLife services.Collaborate with the business...
-
Nurse Specialist
3 days ago
Mechanicsburg, Pennsylvania, United States Public Safety HR Delivery Center Full timeJob Title: Registered NurseJob Summary: We are seeking a skilled Registered Nurse to join our team at the Public Safety HR Delivery Center. As a Registered Nurse, you will be responsible for providing technical support and oversight to facilitate the work of an integrated interdisciplinary health care staff.Key Responsibilities:Monitor and evaluate field...
-
Mechanicsburg, Pennsylvania, United States Concentra Full timeJob Title: Clinical Manager Nurse Practitioner or Physician AssistantWe are seeking a highly skilled Clinical Manager to join our team at Concentra. As a Clinical Manager, you will play a crucial role in providing exceptional care to our patients and leading our clinical team to deliver high-quality services.Key Responsibilities:Provide primary medical...
-
Clinical Field Staff Supervisor
1 week ago
Mechanicsburg, Pennsylvania, United States Kaplan Full timeJob TitleHome Health Clinical Field Staff SupervisorLocationMechanicsburg, PA, USAAdditional Location(s)Employee TypeEmployeeWorking Hours Per Week40Job DescriptionAt Residential Home Health and Hospice, we're seeking a compassionate Clinical Field Staff Supervisor to join our extraordinary care team. Grounded by our belief that outstanding care is best...
-
Clinical Field Staff Supervisor
4 weeks ago
Mechanicsburg, Pennsylvania, United States Residential Home Health and Hospice Full timeJoin Our Team as a Clinical Field Staff SupervisorAt Residential Home Health and Hospice, we're committed to delivering exceptional care to our patients. As a Clinical Field Staff Supervisor, you'll play a vital role in supporting our field staff and leaders to ensure the best possible outcomes.We're a strong leader in the industry, consistently named a Top...
-
Clinical Field Staff Supervisor
2 weeks ago
Mechanicsburg, Pennsylvania, United States Kaplan Full timeJob TitleHome Health Clinical Field Staff SupervisorLocationMechanicsburg, PA, USAAdditional Location(s)Employee TypeEmployeeWorking Hours Per Week40Job DescriptionAt Residential Home Health and Hospice, we're seeking a skilled Clinical Field Staff Supervisor to join our team. As a Clinical Field Staff Supervisor, you will play a vital role in providing...
-
Clinical Field Staff Supervisor
4 days ago
Mechanicsburg, Pennsylvania, United States Kaplan Full timeJob TitleHome Health Clinical Field Staff SupervisorLocationMechanicsburg, PA, USAAdditional Location(s)Employee TypeEmployeeWorking Hours Per Week40Job DescriptionAt Residential Home Health and Hospice, we're seeking a compassionate Clinical Field Staff Supervisor to join our extraordinary care team. Grounded by our belief that outstanding care is best...
-
Radiologic Technologist
4 weeks ago
Mechanicsburg, Pennsylvania, United States UPMC Full timeJob SummaryUPMC is seeking a skilled Radiologic Technologist to join our team as a Mammography Specialist. As a key member of our diagnostic imaging team, you will be responsible for performing imaging procedures at a technical level not requiring constant supervision.ResponsibilitiesPerform and analyze bone density measurements utilizing bone densitometer...
-
Clinical Support Specialist
3 weeks ago
Mechanicsburg, Pennsylvania, United States University of Pittsburgh Medical Center Full timeJob SummaryWe are seeking a highly skilled Medical Assistant to join our team at the University of Pittsburgh Medical Center. As a key member of our clinical staff, you will play a vital role in guiding workflow and assigning tasks to other clinical staff. You will also assist management staff with supervisory activities and participate in the creation and...
-
Clinical Field Staff Supervisor
4 weeks ago
Mechanicsburg, Pennsylvania, United States Residential Home Health and Hospice Full timeAbout the RoleWe are seeking a compassionate Clinical Field Staff Supervisor to join our extraordinary care team at Residential Home Health and Hospice. As a key member of our team, you will partner with our field staff and leaders to provide exceptional support to our patients.With our 20-year track record, Residential is a strong leader in the industry,...
-
LPN Lead
4 weeks ago
Mechanicsburg, Pennsylvania, United States UPMC Full timeJob SummaryUPMC is seeking a skilled LPN Lead to oversee the Endocrinology offices in Lemoyne. This full-time, day shift position offers a unique opportunity to lead a team and provide exceptional patient care.Key ResponsibilitiesAssess patient conditions, take vital signs, and administer medications under the direction of an RN.Train and mentor LPNs and MAs...
-
Radiologic Technologist
4 weeks ago
Mechanicsburg, Pennsylvania, United States UPMC Full timeJob SummaryUPMC is seeking a skilled Radiologic Technologist to join our team as a Mammography Specialist. This role requires a strong foundation in radiologic technology, with a focus on mammography and breast imaging.Key ResponsibilitiesPerform and analyze bone density measurements using a bone densitometer and prepare test results for physician...
-
Clinical Field Staff Supervisor
4 weeks ago
Mechanicsburg, Pennsylvania, United States Residential Home Health and Hospice Full timeJoin Our Team as a Clinical Field Staff SupervisorAt Residential Home Health and Hospice, we're committed to delivering exceptional care to our patients. As a Clinical Field Staff Supervisor, you'll play a vital role in supporting our field staff and leaders to ensure the best possible outcomes.We're a strong leader in the industry, consistently named a Top...