- CHRISTUS Health (Wake Village, TX)
- …Physician Advisor or CMO when discrepancies are present. * Performs the initial clinical medical necessity review utilizing evidence-based criteria and ... Description Summary: The Registered Nurse Clinical Care Coordinator is responsible...management of patients in Observation status to include repeated review of clinical and opportunities for conversion… more
- Eclaro (Utica, NY)
- …make medication sheet for each client that gets injections Complete clinical documentation that meets compliance standards, medical necessity guidelines, ... necessary documentation Maintain spreadsheets for injections/health screens Triage client calls Review client's notes and brief relative staff Answer calls from the… more
- System One (Baltimore, MD)
- …requirements. + Medical Record Retrieval, Abstraction and Research during the Medical Record Review Project + Medical Record Retrieval for ... ALTA IT Services is staffing a contract opportunity for a Clinical HEDIS Specialist support a leading health insurance customer. The main duties include conducting… more
- Hackensack Meridian Health (Little Falls, NJ)
- …educate and support appropriate documentation for coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed ... issues to the Director of the certified operation, Hospice Clinical Director, and the Nurse Manager for...clinical audits. Trend data obtained from reports and review results with managers. + Identify areas for improvement… more
- Hackensack Meridian Health (Brick, NJ)
- …educate and support appropriate documentation for coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed ... issues to the Director of the certified operation, Hospice Clinical Director, and the Nurse Manager for...clinical audits. Trend data obtained from reports and review results with managers. + Identify areas for improvement… more
- Elevance Health (Miami, FL)
- ** Clinical Review Nurse I - Medicare...medical care. + Adapts to a wide variety of medical review topics and multiple Medicare lines of ... 5 pm EST or CST. Hours are flexible.** The ** Clinical Review Nurse I** is...criteria to clearly articulate health information strongly preferred. + Medical Review experience is a plus. +… more
- Centene Corporation (New York, NY)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... cost effectiveness of medical care. + Performs medical necessity and clinical reviews of authorization...with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive… more
- CommonSpirit Health Mountain Region (Durango, CO)
- …flourish and leaders who care about your success. Assist with training and coordinating clinical review and quality assurance. Lead and review the ... clinical care and documentation practices related to patients/residents. Review and evaluate quality data to determine areas needing...of the home health and/or hospice patient. + Registered Nurse + Valid CO Driver's License. + BLS Sedentary… more
- Centene Corporation (Madison, WI)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies… more
- Fresenius Medical Center (New York, NY)
- …regulatory requirements and programs. Collaborates with the Medical Director and the Clinical Coordinator /Charge Nurse or Nurse Supervisor regarding the ... + Addressing patient concerns, issues, and questions including the review of patient satisfaction surveys. + Developing and communicating...with the Clinical Coordinator /Charge RN or Nurse Supervisor and Medical Director to implement… more
