Clinical Review Specialist
24 hours ago
Job Summary:
w3r Consulting is seeking a highly skilled Clinical Review Specialist to join our team. As a Clinical Review Specialist, you will be responsible for conducting thorough reviews of patient care services to ensure medical necessity, appropriate length of stay, and intensity of service.
Key Responsibilities:
- Conduct prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory, and ancillary services to ensure medical necessity and appropriate level of care.
- Establish care plans and coordinate care through the healthcare continuum, including member outreach assessments.
- Collaborate with healthcare providers, facilities, and members to resolve appeal requests and ensure compliance with regulatory requirements.
- Develop and maintain knowledge of healthcare policies, procedures, and regulatory guidelines.
- Provide education and training to healthcare professionals on clinical review processes and best practices.
Requirements:
- Bachelor's degree in nursing, allied health, business, or related field.
- Two to four years of clinical experience, including acute patient care, discharge planning, case management, and utilization review.
- Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes.
- One year of health insurance plan experience or managed care environment preferred.
- Registered Nurse with current unrestricted license required.
- Certification in Case Management may be preferred based on designated department assignment.
Preferred Qualifications:
- Above average computer skills, including Microsoft Office.
- Clinical experience in ICU, ER, or medical surgical unit preferred.
- Utilization management experience preferred.
-
Clinical Nurse Review Specialist
2 weeks ago
Detroit, Michigan, United States Strategic Staffing Solutions Full timeSTRATEGIC STAFFING SOLUTIONS (S3) IS HIRINGPosition: Clinical Nurse Review Specialist Location: Remote (Candidates must reside in Michigan) Contract Duration: 12+ Months Employment Type: W2 Contract Engagement Compensation: $39-42/HR Role OverviewAs a Clinical Nurse Review Specialist, you will conduct thorough evaluations of inpatient, outpatient,...
-
Clinical Nurse Review Specialist
2 weeks ago
Detroit, Michigan, United States Strategic Staffing Solutions Full timePosition: Clinical Nurse Review Specialist Location: Remote (Candidates must reside in Michigan) Contract Duration: 12+ Months Employment Type: W2 Contract Compensation: $39-42 per hour Role Overview: In this role, you will conduct thorough reviews of inpatient, outpatient, ambulatory, and ancillary services to validate medical necessity,...
-
Clinical Nurse
2 weeks ago
Detroit, Michigan, United States Tekwissen Full timePosition Overview:TekWissen Group serves as a prominent workforce management provider across the United States and internationally. Our client operates within the health insurance sector, delivering a variety of healthcare coverage options including individual and family plans, dental and vision coverage, as well as employer-sponsored plans.Job Title:...
-
Clinical Nurse Review Specialist
2 weeks ago
Detroit, Michigan, United States Strategic Staffing Solutions Full timeStrategic Staffing Solutions (S3) is seeking a qualified candidate for the role of RN Review Analyst.Position: RN Review AnalystLocation: Remote (Candidates must reside in Michigan)Contract Duration: 12+ MonthsEngagement Type: W2 Contract PositionRole Overview:The Utilization Management Program is designed to focus on providers, necessitating professional...
-
Clinical Nurse Review Specialist
2 weeks ago
Detroit, Michigan, United States Strategic Staffing Solutions Full timeStrategic Staffing Solutions (S3) is excited to announce a new opportunityPosition: RN Clinical Review ConsultantLocation: Remote (Candidates must reside in Michigan)Contract Duration: 12+ MonthsRole Type: W2 Contract EngagementEngagement OverviewOur Utilization Management Program is centered around provider interactions, necessitating professional...
-
Clinical Reviewer
1 week ago
Detroit, Michigan, United States w3r Consulting Full timeJob Title: Clinical ReviewerWe are seeking a highly skilled Clinical Reviewer to play a critical role in ensuring the quality of patient care at w3r Consulting. As a key member of our team, you will be responsible for reviewing precertification admissions and concurrent reviews to determine the appropriateness of inpatient settings.Key...
-
Clinical Review Nurse
4 days ago
Detroit, Michigan, United States OpTech Full timeAbout the RoleOpTech is seeking a highly skilled Clinical Review Registered Nurse to join our team. As a Clinical Review Registered Nurse, you will play a critical role in ensuring that our clients' UM Program is provider-focused and meets the highest standards of quality and care.Key ResponsibilitiesReview clinical documentation provided by facilities to...
-
Clinical Review Nurse
2 weeks ago
Detroit, Michigan, United States TekWissen LLC Full timeJob DescriptionOverview: TekWissen Group is a leading provider of workforce management solutions across the United States and internationally. Our client operates within the health insurance sector, offering a variety of healthcare coverage options, including individual and family plans, dental and vision insurance, as well as employer-sponsored...
-
Clinical Review Nurse
2 weeks ago
Detroit, Michigan, United States Tekwissen Full timeOverview: TekWissen Group is a prominent workforce management provider operating across the USA and various international markets. Our client, a leading health insurance organization, provides a diverse range of healthcare coverage options, including individual and family plans, dental and vision insurance, as well as employer-sponsored plans. Position:...
-
Nursing Review Specialist
2 weeks ago
Detroit, Michigan, United States Strategic Staffing Solutions Full timeSTRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENINGStrategic Staffing Solutions is currently seeking a Nursing Review Specialist for a contract opportunity with one of our esteemed clients.Title: Nursing Review Specialist Location: Remote (must be local) Duration: 10+ Months Role Type: W2 contract engagement *This position allows for remote work, though...
-
Clinical Review Nurse
2 weeks ago
Detroit, Michigan, United States OpTech Full timeJob Title: Clinical Review NurseWhy consider a career with OpTech?OpTech is a woman-owned organization that prioritizes your insights, fosters your professional development, and consistently supports you. At OpTech, you will enjoy health and dental benefits from your first day, alongside opportunities for training, flexible and remote work arrangements,...
-
Clinical Review Nurse
2 weeks ago
Detroit, Michigan, United States Tekwissen Full timeOverview: TekWissen Group serves as a workforce management provider across the USA and internationally. Our client operates within the health insurance sector, offering a variety of healthcare coverage options including individual and family plans, dental and vision coverage, as well as employer-sponsored plans. Position: Clinical Review Nurse Work...
-
Clinical Review Nurse
2 weeks ago
Detroit, Michigan, United States PSG Global Solutions Careers Full timeJoin our team and connect with a dedicated recruiter who understands your career aspirations. Position Overview Role Summary We are seeking a Clinical Review Nurse to work within the Healthcare sector. Utilize established medical protocols and criteria to conduct thorough reviews of medical necessity for post-acute care services, ensuring appropriateness...
-
Registered Nurse Clinical Reviewer
1 week ago
Detroit, Michigan, United States Strategic Staffing Solutions Full timeStrategic Staffing Solutions (S3) is a leading provider of staffing solutions.We are currently seeking a highly skilled Registered Nurse Clinical Reviewer to join our team.About the Role:As a Registered Nurse Clinical Reviewer, you will be responsible for:Conducting thorough reviews of patient records to ensure accurate and high-quality care.Collaborating...
-
Healthcare Review Specialist
2 weeks ago
Detroit, Michigan, United States W3R Consulting Full timePosition Title: Clinical Review NurseCompany: W3R ConsultingJob Overview:This role involves conducting comprehensive evaluations of inpatient, outpatient, and ancillary services to ensure medical necessity and appropriate care levels. The Clinical Review Nurse will play a crucial role in establishing care plans and coordinating patient care throughout the...
-
Clinical Nurse Reviewer
2 weeks ago
Detroit, Michigan, United States TekWissen LLC Full timeJob OverviewCompany: TekWissen LLCPosition: Registered Nurse - Review AnalystWork Type: RemoteContract Duration: 9 MonthsDepartment: Commercial Inpatient ServicesPosition SummaryTekWissen LLC is a prominent workforce management provider operating across the USA and internationally. Our client, a leading health insurance organization, offers a variety of...
-
Phlebotomy Specialist
5 days ago
Detroit, Michigan, United States Biotech Clinical Laboratories Full timeJob SummaryBiotech Clinical Laboratories is seeking a skilled Phlebotomy Specialist to join our team.Key Responsibilities:Collect and process patient specimens for laboratory testing.Float to different office locations as needed to support the business.Verify and enter patient data, confirm written and electronic orders using laboratory technology.Work...
-
Clinical Nurse Specialist
22 hours ago
Detroit, Michigan, United States Henry Ford Health System Full timeJob SummaryHenry Ford Health System is seeking a highly skilled Clinical Nurse Specialist to provide leadership and clinical expertise within the National Association of Clinical Nurse Specialists (NACNS) spheres of influence. The successful candidate will be responsible for improving patient care, advancing nursing practice, and impacting the healthcare...
-
Telephonic Clinical Assessment Specialist
1 week ago
Detroit, Michigan, United States Detroit Wayne Integrated Health Network Full timeUnder the supervision of the Call Center Administrator, the Clinical Specialists are tasked with conducting telephonic clinical evaluations and assessments to ascertain eligibility for the public mental health system, ensuring that clients receive the necessary level of care.KEY RESPONSIBILITIES:Assess appropriate levels of care for referrals, guiding...
-
Telephonic Clinical Assessment Specialist
2 weeks ago
Detroit, Michigan, United States Detroit Wayne Integrated Health Network Full timeUnder the general oversight of the Call Center Administrator, the Call Center Clinical Specialists are tasked with conducting telephonic clinical evaluations and assessments to ascertain eligibility for the public mental health system, ensuring that clients receive the necessary level of care.KEY RESPONSIBILITIES:Assess appropriate levels of care for...