- Medical Mutual of Ohio (OH)
- …Advantage, Medicare Supplement, and individual plans. Under limited supervision, the Medicare Nurse Reviewer applies medical necessity guidelines in ... for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Responsibilities** + Evaluates clinical information… more
- Lowe's (Charlotte, NC)
- …a clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Experience in a clinical position + 1-2 ... for medically managing a minimum caseload of 65 including review of claims identified for Medicare Set-Aside....Clinical experience + 3-5 Years of Experience required with Nurse Case Management Software, along with Microsoft Office +… more
- Elevance Health (Miami, FL)
- **Clinical Review Nurse I - Medicare Part A & B** National Government Services is a proud member of Elevance Health's family of brands. We administer ... pm EST or CST. Hours are flexible.** The **Clinical Review Nurse I** is responsible for reviewing...care. + Adapts to a wide variety of medical review topics and multiple Medicare lines of… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Manages utilization of ... of services and procedures. Manages initial, concurrent, and retrospective review of cases, including appeals, through evaluation of clinical information… more
- Medical Mutual of Ohio (OH)
- …are looking for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Founded in 1934, Medical Mutual is the ... insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.** Under limited… more
- AdventHealth (Orlando, FL)
- …collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...mortality (ROM), and quality. Completes accurate and timely record review to ensure the integrity of documentation compliance. Completes… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063,...to enroll eligible individuals who are either Medicaid or Medicaid/ Medicare recipients and optimize their ability to remain in… more
- MetroHealth (Cleveland, OH)
- …of additional comorbid conditions. Conducts concurrent and retrospective medical record review on defined patient populations to identify opportunities to improve ... minimum of 3 years of CDI experience or; - CDI Second Level Reviewer with a strong understanding of disease processes, clinical indications and treatments, provider… more
- SSM Health (MO)
- …- five years acute inpatient care experience preferred. + Mortality and PSI review experience preferred.. + Epic and Vizient experience preferred. We are hiring for ... risk adjustment (mortality) findings. + Maintains knowledge of Centers for Medicare and Medicaid Services (CMS) requirements related to clinical documentation and… more
- The Cigna Group (Bloomfield, CT)
- …effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and ... Medical Directors when services do not meet criteria or require additional review . * Participation in staff meetings, regular trainings and other collaborative… more