- Actalent (Atlanta, GA)
- Actalent is currently hiring for Remote Utilization Review RNs! Job Description: + Reviewing authorization requests + Utilizing evidence-based criteria and ... if applicable. Qualifications: + Active RN License + Prior Utilization management/Concurrent review experience + Experience with MCG Why Actalent? + Work with a… more
- Providence (WA)
- …retain the best people, we must empower them._** **Providence Health Plan is calling a Clinical Nurse Auditor, HEDIS who will:** + Be responsible for conducting ... Information Set (HEDIS) program + Conduct Audits, which include review of outpatient medical records, hospital records, clinical...position include:** + Degree in Nursing + Oregon Registered Nurse License + 5+ years clinical experience… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding ... adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical ...and mandates. + Organizes the appeal case for physician review by compiling clinical , contractual, medical policy… more
- Rising Medical Solutions (Chicago, IL)
- …was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment. ... maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee...neuro, rehab, or ER procedures + 3-5 years of clinical experience in acute care, surgery and/or orthopedic +… more
- Centene Corporation (New York, NY)
- …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, ... on workplace flexibility. **Must have an active New York State clinical license.** **Position Purpose:** Analyzes all prior authorization requests to determine… more
- Prime Therapeutics (Des Moines, IA)
- …Description Summary** This position has managerial and clinical oversight of the Clinical Pharmacist and Registered Nurse Review Team, playing a key ... drives every decision we make. **Job Posting Title** Supervisor Clinical Pharmacist Review - Remote ...the clinical performance of a team of Clinical Pharmacist and Nurse Reviewers while supporting… more
- Centene Corporation (Madison, WI)
- …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, ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- System One (Baltimore, MD)
- ALTA IT Services is staffing a contract opportunity for a Clinical HEDIS Specialist support a leading health insurance customer. The main duties include conducting ... other needs within the Quality Department. Pay: $37/HR 90% Remote May need to go onsite in Baltimore, MD...found. Correct errors identified through over-read process, including a re- review of charts that may contain similar errors. +… more
- Centene Corporation (Sacramento, CA)
- …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, ... competitive benefits including a fresh perspective on workplace flexibility. **Fully Remote position that requires a CA RN Licensure.** **Position Purpose** :… more
- AmeriHealth Caritas (Florence, SC)
- ** REMOTE | Care Manager II Registered Nurse (BSN) - Foster Care Program -SC** Location: Florence, SC Primary Job Function: Medical Management ID**: 34390 **Job ... Counties preferred are York, Florence, Darlington, Williamsburg and Horry. RN required. ** Remote to qualified candidates living in South Carolina with a preference… more