Clinical Utilization Review Specialist

Job SummaryClinical Utilization Review Specialist sought for a part-time, weekend position at Grace Medical Center. The ideal candidate will possess strong critical thinking skills and the ability to perform clinical/chart review and abstract information efficiently.Key ResponsibilitiesConduct concurrent and retrospective chart review for clinical,...

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 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 SummaryLifeBridge Health is seeking a skilled Utilization Review Nurse to conduct concurrent and retrospective chart reviews for clinical, financial, and resource utilization information. The ideal candidate will provide intervention and coordination to decrease avoidable delays and denial of payment.Key ResponsibilitiesReview medical records by applying...

Utilization Review and Case Management RN - Part Time, WeekendsAt LifeBridge Health, we are seeking a skilled Utilization Review and Case Management RN to join our team. As a key member of our healthcare team, you will be responsible for conducting concurrent and retrospective chart reviews to identify opportunities for improvement in clinical, financial,...

Job DescriptionWalker Health Services is seeking a strategic Utilization Review Manager to lead our Utilization Review department. This individual will oversee the UR process, ensuring compliance with state-specific guidelines, and develop policies and procedures for internal workflows and client interactions.The Manager will focus on optimizing UR...

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 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 SummaryWe are seeking a skilled Healthcare Utilization Specialist to join our team at Collabera. As a key member of our clinical team, you will be responsible for providing administrative support related to pre-service, utilization review, care coordination, and quality of care.Key ResponsibilitiesPerform member or provider related administrative tasks...

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 SummaryLifeBridge Health is seeking a skilled Utilization Review and Case Management RN to join our team. As a Utilization Review and Case Management RN, you will play a critical role in ensuring the efficient use of healthcare resources while providing high-quality patient care.Key Responsibilities:Conduct concurrent and retrospective chart reviews to...

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 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 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...

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%...

Alta IT Services is seeking a HEDIS Quality Specialist to support a leading health insurance customer. The ideal candidate will have experience with chart retrieval and medical record reviews using proprietary tools and software.Key Responsibilities:Conduct thorough medical record reviews to ensure data accuracy and qualityUtilize proprietary tools and...

Job Summary: We are seeking a skilled Clinical HEDIS Specialist to support our Quality Department in conducting thorough HEDIS overreads and medical record retrievals. The ideal candidate will have experience in HEDIS abstraction and review, as well as strong analytical and communication skills.Key Responsibilities:Conduct thorough HEDIS overreads in line...

Job Title: Clinical Nutrition SpecialistWe are seeking a skilled Clinical Nutrition Specialist to join our team at RD Nutrition Consultants LLC. As a Clinical Nutrition Specialist, you will be responsible for conducting comprehensive nutrition assessments and developing individualized plans for Medical Nutrition Therapy (MNT).**Responsibilities:*** Conducts...

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 Summary:As a Clinical Medical Review Nurse at Mindlance, you will play a critical role in ensuring the accuracy and quality of healthcare data. You will be responsible for conducting thorough HEDIS overreads, reviewing medical records, and identifying errors. Your attention to detail and strong analytical skills will be essential in this role.Key...