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Jul 19 Coord Util Review PRN as needed .001 (01345-3568) HCA Healthcare Plantation, FL

for the implementation of the review process. Monitors physician ... Westside Regional Medical Center, a 224-bed medical center and healthcare complex. Here,... more

Jul 18 CLINICAL CLAIMS REVIEW NURSE - COAST HEALTHCARE MANAGEMENT Tenet Healthcare Lakewood, CA

five years experience in Utilization Review, Medical Coding or Health Experience ... information. * Certified coder; Certified Medical Audit Specialist (CMAS)... more

Jul 17 Lead Claims Review Analyst (Nurse Reviewer) Ces Peoria, AZ

Experience- Previous Medicare Medical Review experience is preferred. Experience ... reviewing medical claims to determine medical necessity and appropriateness is... more

Jul 16 LPN/Medical Reviewer North Carolina

to back up review determination · Review interdepartmental requests and medical ... internal/external staff regarding medical reviews, medical terminology, coverage... more

Jul 15 Appeals/Retrospective/Medical Claims Review RN Amalgamated Life Insurance Salem, NH

guidelines and physician support to provide medical review of appellate and retrospective ... closure with accurate documentation of all review outcomes.Applies medical criteria... more

Jul 14 Clinical Care Reviewer UM - RN AmeriHealth Caritas Philadelphia, PA

Management, the Clinical Care Review Nurse is responsible for completing medical ... cases to KFHP Medical Director for medical necessity review when medical information... more

Jul 10 Medicare Medical Review Nurse NCI Information Systems Omaha, NE

NCI: Medicare Medical Review QA Nurse ( Quality Control Specialist IV ), you will perform ... You will support the Medical Review management staff and the Lead Claims Review Analysts b... more

Jul 10 Registered Nurse (UTILIZATION REVIEW LEAD NURSE) U.S. Department of Veterans Affairs New Orleans, LA

Serves as the Lead Nurse/VIP Liaison, Utilization Review for the Office of Cultural Transf ... care review and evaluation that assesses medical necessity of admission,... more

Jul 08 Utilization Review Nurse RN Novant Health Salisbury, NC

medical necessity reviews. All Utilization Review activities are performed in accordance ... Utilization Review or related experience preferred. * Licensure/certification/registration... more

Jul 07 Medical Bill Review Nurse (RN) Healthcare Scouts Haltom City, TX

position. In this role as a Medical Bill Review Nurse, you will engage in case review ... care plans are established, managed and medical personnel have followed the... more

Jul 05 Healthcare Physician Practice Consultant / Medical File Review Nurse - Jefferson County UnitedHealth Group Watertown, NY

Medical/clinical background desirable (NP) - 7+ years ... nurse, nurse practitioner, RPN, Medical File Review, Medical Coding Careers with... more

Jul 05 Healthcare Physician Practice Consultant / Medical File Review Nurse UnitedHealth Group New York City, NY

Medical/clinical background desirable (NP) - 7+ years ... nurse, nurse practitioner, RPN, Medical File Review, Medical Coding Careers with... more

Jul 03 Medical Services Reviewer(257829) Kaiser Permanente Aurora, CO

for ensuring ongoing compliance for Medical Review. Maintains knowledge of ... Participates in establishing medical review policies and procedures and works... more

Jun 27 Medical Review Nurse - Home Health Adventist Health System Corporate Port Charlotte, FL

currently seeking qualified candidates for a Medical Review Nurse position that will be ... nursing Currently a licensed registered nurse Software Requirements: Horizon Home... more

Jun 26 Senior Coordinator Medical Record Review Healthcare Scouts Seattle, WA

the integration of medical records review (MRR) data into administrative ... As the Senior Coordinator, Medical Record Review you will be responsible for... more

Jun 24 Claims Review Nurse/Medical Advisor - Largo M Computer Sciences Corporation (CSC) Upper Marlboro, MD

Job Description Job Title: Claims Review Nurse/Medical Advisor - Largo MD ... Review Nurse/Medical Advisor. The Claims Review Nurse/Medical Advisor will be... more

Jun 24 Medical Claims Review Nurse Job Yoh Staffing Sacramento, CA

Medical Claims Review Nurse needed for a contract opportunity with Yoh's client located in ... review of claims requiring medical review, edits, and medical necessity... more

Jun 23 RN Utilization Review Per Diem Siena campus(1400010587) St Rose Dominican - Siena Henderson, NV

criteria. Job Summary The Utilization Review Nurse is responsible for coordinating ... Medical/clinical knowledge, technical and clinical skills, clinical judgment, interpersona... more

Jun 20 Medical Review Nurse I Strategichealthsolutions Omaha, NE

Medical Review Nurse I – ID061214NE/MD Omaha, NE or Columbia, MD Job Summary: Performs ... medical record review and evaluation of medical services being audited Analyzes... more

Jun 10 RN Manager Utilization Review (232492-005) Concentra Fort Lauderdale, FL

Nurse • 3+ years’ experience in Utilization and Quality Improvement • HEDIS ... under the direction of the Center Medical Director. Demonstrated excellent... more

May 30 CASE REVIEW COORDINATOR, RN, Per Diem Faulkner Hospital Boston, MA

us make a difference. Requirements Case Review Coordinator- Case Management, per ... in-patient Case Management and Utilization Review. Basic computer knowledge. Experience... more

May 20 Clinical Care Reviewer RN --Utilization Management Medicaid HMO AmeriHealth Caritas Baton Rouge, LA

medical necessity review. It is within the nurse’s discretion to pend requests for ... cases as needed. The nurse will apply medical health benefit policy and medical... more

May 07 Anesthesia Quality Review Registered Nurse RN Coordinator Lahey Health Burlington, MA

review as well as retrospective chart review. 3) Interacts with caregivers to ... Acts as member or facilitator on hospital or medical committees, preparing agendas,... more

Feb 23 Utilizat Review LPN Novant Health Charlotte, NC

care, level of care, and quality of care medical reviews for hospitalized patients. ... initial, concurrent, and retrospective medical record reviews. Makes utilization... more

Aug 01 Utilization Review NurseMedical Services Advantage Healthcare Management Company Phoenix, AZ

Healthcare Management Company Department: Medical Services Schedule: Full Time Shift: ... facilities. Determines and documents medical necessity based on Milliman criteria. more

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