Leader, the Nurse Case Manager I functions as a member of the clinical team. This role coordinates a plan of care to achieve... for more details. Prior leadership experience preferred. One year of case management and/or utilization review work experience preferred...
perspective on workplace flexibility. ***Applicants must possess NY RN State Licensure*** Position Purpose: Analyzes all prior... quality and cost effectiveness of medical care. Performs medical necessity and clinical reviews of authorization requests...
weekends. Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service... medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance...
to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards... of resources. Key Responsibilities: Conducts clinical reviews of prior authorization requests to evaluate medical necessity...
to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards... of resources. Key Responsibilities: Conducts clinical reviews of prior authorization requests to evaluate medical necessity...
. DUTIES & RESPONSIBILITIES 1. Authorization and Review o Evaluate and process prior authorization requests for medical... Authorization (PA) Nurse is a full-time role with NeueHealth, dedicated to promoting quality and cost-effective outcomes for the...
with organizational standards is submitted by physician prior to scheduled procedure. Performing and submitting clinical information... that physician documentation supports current clinical level of care. Communicating and collaborating with Intake Nurse/Care...
Review RN for a contract opportunity with one of our largest clients located in Vermont! Title: Clinical Review Registered... or a medical director for review. PRIMARY RESPONSIBILITIES: Conduct clinical reviews of all prior approval, post-service...
clinical acumen and the appropriate application of policies and guidelines to Managed Care prior authorization referral... review a referral. Fosters the relationship between the Pre-Authorization team and the Medical Director and Physician...
, Preservice Review Nurse, you will be responsible for performing pre-service clinical coverage review of services that require... Qualifications: Undergraduate degree (BSN) or equivalent experience Utilization management and prior authorization experience...
, Preservice Review Nurse, you will be responsible for performing pre-service clinical coverage review of services that require... Qualifications: Undergraduate degree (BSN) or equivalent experience Utilization management and prior authorization experience...
of inpatient clinical experience. 1+ year in prior authorization reviews using InterQual. Strong written communication skills... balance, continuous learning, and career development. Summary We are seeking a skilled Utilization Review Nurse to conduct...
of inpatient clinical experience. 1+ year in prior authorization reviews using InterQual. Strong written communication skills... balance, continuous learning, and career development. Summary We are seeking a skilled Utilization Review Nurse to conduct...
Our Client, a Mutual Insurance Holding company, is looking for a Medical Review Nurse (RN) for their Remote location.... Responsibilities: Review and authorize, as appropriate, phone/fax referral/authorization and clinical form requests per established...
appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general... CA Registered Nurse (RN) license. Preferred Qualifications: - 7 years UM experience with Charge/Lead/Supervisory/Management...
experience. and Prior experience with Epic CCM. Licenses and Certifications (RN) REGISTERED NURSE Holds an active...Utilization Review RN - PRN - Monday-Friday Days Three (3) years of utilization review experience in acute care...
. Growing together. The Preservice Review RN is responsible for reviewing requests received from providers, using approved... Maintain 100% accuracy of clinical review case notes in Facets Maintain productivity standards and maintain compliance...
experience. and Prior experience with Epic CCM. Licenses and Certifications (RN) REGISTERED NURSE Holds an active...Utilization Review RN - PRN - Monday-Friday Days Three (3) years of utilization review experience in acute care...
, however, must hold an RN license per position requirements. Position Summary: The Utilization Review Nurse / Quality... Associate position facilitates the prior authorization of managed care patients. The utilization review component of the...
documentation Conduct prior authorization and concurrent reviews in accordance with clinical guidelines and organizational policy...Utilization Review Nurse – LTSS (Contract-to-Perm) Location: Remote however Candidates must reside in one of the...