NewSCO RN UM Reviewer NeighborHealth CorpSCO RN UM ReviewerMA$44–$64 / hourThe successful candidate will be able to perform the following responsibilities: Communicates results of reviews verbally, in the medical record, and through official written notification to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements. Maintains consistent communication and collaboration with CCA UM team and SCO team relating to updates and program issues; ensures that Directors/Managers and peers are also informed of these matters.
Case Manager-Registered Nurse (RN)-PRN Houston MethodistCase Manager-Registered Nurse (RN)-PRNTexasCollaborates with the physician and all members of the interprofessional health care team to facilitate care for designated case load; monitors the patient’s progress, intervening as needed to ensure that the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective; facilitates timely: • completion and reporting of diagnostic testing; • completion of treatment plan and discharge plan; • modification of plan of care, as necessary, to meet the ongoing needs of the patient; • assignment of appropriate levels of care; • completion of all required documentation in EPIC and MIDAS. Identifies when services no longer meet InterQual/Millman l criteria, initiates discussion with attending physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from the physician advisor, if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage.
Case Manager / RN (PRN) Houston MethodistCase Manager / RN (PRN)PEOPLE ESSENTIAL FUNCTIONS Collaborates with the physician and all members of the interprofessional health care team to facilitate care for designated case load; monitors the patient’s progress, intervening as needed to ensure that the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective; facilitates timely: • completion and reporting of diagnostic testing; • completion of treatment plan and discharge plan; • modification of plan of care, as necessary, to meet the ongoing needs of the patient; • assignment of appropriate levels of care; • completion of all required documentation in EPIC and MIDAS. Identifies when services no longer meet InterQual/Millman l criteria, initiates discussion with attending physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from the physician advisor, if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage.
Denials RN Coordinator Ensemble Health PartnersDenials RN CoordinatorOHRemote$62,500–$79,800 / yearJob duties include but are not limited to: understanding insurance contract terms, reviewing claim denials and underpayments to determine if additional payment amounts can be expected, analyzing medical records and determining if a member or an Independent Review organization (IRO) appeal is necessary, understanding payer medical policy guidelines, preparing IRO appeal documentation which may include correcting and resubmitting claims, gathering additional information, reviewing medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting provider, member and IRO/ALJ appeals in a timely manner. Extensive review of medical records for medical necessity criteria, filing written letters of appeal on denied claims, filing complaints with state Department of Insurance, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner.
NewRegistered Nurse (Occupational Health Medical Reviewer) CetechsRegistered Nurse (Occupational Health Medical Reviewer)Springield, VARemoteCetechs is seeking experienced Registered Nurses (RNs) to support the Transportation Security Administration (TSA) Candidate Assessment and Review for Eligibility Support (CARES) program. Active, unrestricted Registered Nurse (RN) license in Virginia (or ability to obtain prior to start).
NewSenior Registered Nurse Integrated Resources, IncSenior Registered NurseChattanooga, TennesseeFull timeUtilizes the following system applications when performing reviews: FACETS, FileNet, Outlook, and Intranet, Internet Explorer to research and cross-reference diagnoses and treatment, Microsoft Office, Encoder Pro, Adobe Reader, Adobe Writer, and TRH Imaging software to review applications for potential misrepresentation referrals. IT Life Sciences Allied Healthcare CROCertified MBE |GSA - Schedule 66 I GSA - Schedule 621IDIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549
NewClinical Care RN Integrated Resources, IncClinical Care RNHarrisburg, PennsylvaniaFull timeIT Life Sciences Allied Healthcare CRO(Direct) 732-844-8721 | (W) 732-549-2030 x 311 | (F) 732-549-5549"INC 5 0 0 0 's FASTEST GROWING, PRIVATELY HELD COMPANIES" (8th Year in a Row) Job DescriptionPosition Summary: Responsible for conducting timely reviews of all requests for services required to meet medical necessity criteria to include reviewing pre-certification for outpatient and inpatient services.
RN Reviewer Cohere Health Technologies LLCRN ReviewerCARemote$2,022–$2,025Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes. You will work closely with Medical Directors and other Cohere Health staff to ensure appropriate cost-effective care by applying your clinical knowledge and critical thinking skills to assess the medical necessity of inpatient admissions, outpatient services and procedures, and provider out of network requests.
Nurse Specialist II, Clinical Denials Knowtion HealthNurse Specialist II, Clinical DenialsRemoteThe Appeals Nurse works with attorneys and claims representatives by reviewing and appealing claims when appropriate to overturn clinical denials from Medicare, Medicaid, and other third-party payers. Knowtion Health culture is inviting and competitive, embracing challenge and celebrating accomplishment; dedicated colleagues striving to provide quality results that have lasting impact.
UM BH Registered Nurse HumanaUM BH Registered NurseOlympia, WARemoteUse your skills to make an impact** **Required Qualifications:** + **You must be a transitioning service member eligible to participate in the DOW SkillBridge or a military spouse eligible to participate in the military spouse fellowship** · + Active Registered Nurse, RN, in the state of Kentucky or an enhanced Compact, (eNLC) license without restrictions or disciplinary action.· + **Minimum two, (2) years of clinical behavioral health experience.** + Proficiency in healthcare software and electronic medical records (EMR) systems. **Workstyle:** Remote Work at Home **Location:** Must reside in a state that participates in the enhanced compact license, (eNLC) **Work Schedule:** Weekdays 8:00 AM to 4:30 PM Central Time **Travel:** None **Additional Information** **Work At Home Requirements** + WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office.
Senior RN Clinical Care Navigation & Vendor Liaison Coordinator TexicareSenior RN Clinical Care Navigation & Vendor Liaison CoordinatorTexasYou will collaborate closely with customer experience, sales, employer groups, brokers, provider relations, network, compliance, and operational teams to navigate challenges related to care management, provider access, transitions of care, and utilization management services, while helping establish best practices and processes for the future. Working within a managed care environment that partners with delegated clinical vendors, you will act as a key liaison between the health plan, vendor clinical teams, and internal stakeholders to help resolve member care concerns and support a seamless healthcare experience.
NewRN Case Manager, CCH Community Health SystemRN Case Manager, CCHFresno, CaliforniaCase management will include: educating patients about medication; encouraging adherence; promoting risk reduction and healthy lifestyle choices; and following up with patients to ensure medication is taken, appointments are made, and labs are completed. Experience 2 years of experience as a Registered Nurse with experience in discharge planning, case management, or utilization management required or 5 years of LVN experience in discharge planning, case management, or utilization management required .
Utilization Management Supervisor Non-Clinical UCLA Health SystemUtilization Management Supervisor Non-ClinicalLos Angeles, CA$70,900–$145,200 / yearb'nn n n n n n n n n n n n nn n n n n n n n n n n n n n n n n n Utilization Management Supervisor, Non-Clinical - - 31153 - UCLA Healthn n nnnn nn n n n nn n n n n Skip to content nn n n n n n UCLA Health Home Page n n nn nnn n nn n Main menu. Press enter or space keys to expands and escape key to collapse nn n n n n n n Sear...
NewRN Case Management Coordinator BlueCross BlueShield of South CarolinaRN Case Management CoordinatorSouth CarolinaProvides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div.
ADON - RN Greenspring Village by Erickson Senior LivingADON - RNSpringfield, VA$115,000 / yearSee Erickson Senior Living Privacy Policy at https://www.ericksonseniorliving.com/privacy-policy and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions. Step into a rewarding role as our ADON, where you’ll play a key part in shaping clinical leadership and enhancing outcomes across our Assisted Living and Memory Care neighborhoods .
NewCase Management Coordinator (RN or Social Worker) BlueCross BlueShield of South CarolinaCase Management Coordinator (RN or Social Worker)South CarolinaRemoteProvides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as social worker from the United States and in the state of hire (in Div.
RN Care Manager Acute Orlando Health Ventures l LLCRN Care Manager AcuteLakeland, FLOpening in summer 2026, Orlando Health Watson Clinic Lakeland Highlands Hospital - a state-of-the-art, seven-story, multi-specialty hospital - will serve as a vital 550,000 square-foot healthcare hub offering: 300+ inpatient beds and 69 emergency and observation beds 11 operating rooms and four cardiac interventional suites Dedicated labor and delivery services - including a neonatal intensive care unit (NICU) that will debut shortly after the hospital opens Comprehensive cardiovascular, neurology, and oncology services Advanced surgical procedures Join us in shaping the future of healthcare in Polk County as part of the Orlando Health Watson Clinic Lakeland Highlands Hospital opening team and share in the privilege of saying you were there from the very beginning. Shift: Second Shift 2pm-10pm Responsibilities nitially and concurrently assesses all patients within assigned population to include, but not limited to: Accurate medical necessity screening and submission for Physician Advisor review Care coordination that includes admitting diagnosis/ medical history, current treatments, age, payment source, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, special/ personal needs, and other relevant information.
Case Manager (RN) - Timely Discharge - 1.0 FTE, 8-HR, Day Shift Stanford Health CareCase Manager (RN) - Timely Discharge - 1.0 FTE, 8-HR, Day ShiftPALO ALTO, CA$96.35–$111.14 / hourOther - Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned. Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration.
Case Manager (RN) - Inpatient - 1.0 FTE, 08-hr, Day Shift Stanford Health CareCase Manager (RN) - Inpatient - 1.0 FTE, 08-hr, Day ShiftPalo Alto, CA$96.35–$111.14 / hourOther - Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned. Monitors patients'' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient''s clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration.
Case Manager (Rn) - Inpatient - 0.8 Fte, 08-Hr, Day Shift Stanford Health CareCase Manager (Rn) - Inpatient - 0.8 Fte, 08-Hr, Day ShiftPalo Alto, CA$96.35–$111.14 / hourOther- Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned. Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration.
Case Manager (Rn) - Inpatient - 1.0 Fte, 08-Hr, Day Shift Stanford Health CareCase Manager (Rn) - Inpatient - 1.0 Fte, 08-Hr, Day ShiftPalo Alto, CA$96.35–$111.14 / hourOther- Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned. Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration.
Case Manager (RN) - Inpatient - 1.0 FTE, 08-HR, Day Shift Stanford Health CareCase Manager (RN) - Inpatient - 1.0 FTE, 08-HR, Day ShiftPalo Alto, CA$96.35–$111.14 / hourOther - Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned. Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration.
RN, HCAT Administrator University of RochesterRN, HCAT AdministratorRochester, NY$84,557–$118,380 / yearCollaborates with contacts in finance, contracting, department administration, legal, pharmacy, nursing, and medical ethics to ensure successful and financially sustainable FDA-approved gene- and cell-based therapy programs across all relevant clinical areas of the institution. Develops and maintains knowledge and competence related to cell- and gene-based therapies through continuing education, conferences, primary literature, liaison activities with peers, peer organizations, and manufacturers, and any other means necessary.
RN Ambulatory Care Manager Intermountain Health IncRN Ambulatory Care ManagerSt George, UT$41.20–$62.17 / hourFrequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations. Collaborating effectively with patients, families/caregivers, healthcare providers, payers, community-based providers, and other involved parties ensures efficient, effective, and patient-centered care management services.
LVN Actalent IncLVNOxnard, CA$33–$37 / hourWe are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing winner for both client and talent service. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
Quality Nurse – QAPI Coordinator Innovative Health CareQuality Nurse – QAPI CoordinatorScottsdale, Arizona$75,000–$85,000The Quality Nurse will conduct clinical chart audits, review documentation for accuracy and compliance, ensure appropriate ICD-10 and CPT coding practices, and support adherence to Medicare and state regulatory requirements. Position Summary The Quality Nurse – QAPI Coordinator is responsible for supporting and managing the organization’s Quality Assurance and Performance Improvement (QAPI) program under the direction of the Program Director.
NewClinical Reviewer-PRN (RN) Acentra Health, LLCClinical Reviewer-PRN (RN)Remote$28.37–$39.19 / hourPart timeIn fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education.
Inpatient RN Care Manager Advocate Aurora Health IncInpatient RN Care ManagerPark Ridge, IL$38.20–$57.30 / hourServes as an active member of the Outcome Facilitation Team/Patient Care Multidisciplinary Team and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities. Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays.
NewTravel Nurse RN - Case Manager - $2,005 per week in Chapel Hill, NC Cynet HealthTravel Nurse RN - Case Manager - $2,005 per week in Chapel Hill, NCChapel Hill, NC$2,005Job Title: Care Manager Profession: RN Specialty: Case Management Duration: 13 weeks Shift: Days Hours per Shift: 40 Experience: Two (2) years of health care experience as a Registered Nurse License: Licensed to practice as a Registered Nurse in the state of North Carolina Certifications: Nursing Diploma or ADN/ASN from an accredited school of Nursing Must-Have: DISCHARGE PLANNING CRITICAL THINKING CASE MANAGEMENT UTILIZATION REVIEW PATIENT ASSESSMENT Description: The purpose of this position is to provide ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual patient needs. Provide education on community resources, support groups, and appropriate resources to patients, families, and the care team.
RN or Social Worker, Case Manager: PRN Firelands Regional Medical CenterRN or Social Worker, Case Manager: PRNSandusky, OHWe are locally managed and governed as a not-for-profit healthcare facility, serving the counties of Erie, Ottawa, Sandusky, and Huron, covering a regional service area with over 300,000 residents. What You Will Do: Makes patient rounds with and without physician to evaluate and assess the needs of the patient, assigning a designated level of risk of identified barriers to plan of care and discharge/transition needs.
RN Care Manager Advocate Aurora Health IncRN Care ManagerDowners Grove, IL$38.20–$57.30 / hourServes as an active member of the Outcome Facilitation Team/Patient Care Multidisciplinary Team and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities. Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays.
NewCase Management Manager RN Nursing Pro StaffingCase Management Manager RNFloridaThis position requires knowledge of Resource Management, under and over utilization, discharge planning, Medicare and government payer regulations, quality control and process improvement activities as related to Utilization Management. · You will ensure effective, flexible utilization of staff within staffing guidelines, taking into consideration the staffs competency and patient acuity.
RN Or Social Worker, Case Manager: PRN Firelands Regional Medical CenterRN Or Social Worker, Case Manager: PRNSandusky, OHWe are locally managed and governed as a not-for-profit healthcare facility, serving the counties of Erie, Ottawa, Sandusky, and Huron, covering a regional service area with over 300,000 residents. What You Will Do: Makes patient rounds with and without physician to evaluate and assess the needs of the patient, assigning a designated level of risk of identified barriers to plan of care and discharge/transition needs.
Case Manager III, Ambulatory ( RN ) Sutter HealthCase Manager III, Ambulatory ( RN )San Francisco, CA$90.58–$126.81 / hourEmployees of Sutter Health and its entities may handle hazardous drugs in the course of their work, including patient care, which requires them to manage, store, prepare, receive, unpack, transport, dispose of, or administer drugs identified as hazardous or potentially hazardous by the National Institute for Occupational Safety and Health (NIOSH) and in accordance with the USP 800 guidelines. Position Overview: Serves as a Case Manager (CM) Subject Matter Expert (SME) performing case management roles and functions, with a focus on InterQual medical necessity reviews, training newly hired team members, quality assurance and support.
UM Nurse Reviewer Astiva HealthUM Nurse ReviewerOrange, CA$75,000–$95,000 / yearSUMMARY: The Utilization Management Authorization Review Nurse is responsible for managing inpatient & outpatient utilization by conducting thorough reviews of clinical documentation and applying clinical knowledge in accordance with relevant Care Guidelines and CMS regulations. This policy relates to all phases of employment, including but not limited to recruiting, employment, placement, promotion, transfer, demotion, reduction of workforce and termination, rates of pay or other forms of compensation, selection for training, the use of all facilities, and participation in all company sponsored employee activities.
Case Manager Iii, Ambulatory ( RN ) Sutter HealthCase Manager Iii, Ambulatory ( RN )San Francisco, CA$90.58–$126.81 / hourEmployees of Sutter Health and its entities may handle hazardous drugs in the course of their work, including patient care, which requires them to manage, store, prepare, receive, unpack, transport, dispose of, or administer drugs identified as hazardous or potentially hazardous by the National Institute for Occupational Safety and Health (NIOSH) and in accordance with the USP 800 guidelines. Position Overview: Serves as a Case Manager (CM) Subject Matter Expert (SME) performing case management roles and functions, with a focus on InterQual medical necessity reviews, training newly hired team members, quality assurance and support.
RN Admissions Acadia Healthcare Co IncRN AdmissionsHaverhill, MA$40–$50 / hourThis position plays a critical role in connecting patients to care by coordinating referrals, facilitating communication between referral sources and providers, completing admissions when necessary, and ensuring a smooth and efficient admissions process. EMPLOYEE BENEFITS: At Acadia Healthcare, we offer a comprehensive benefits package including medical, prescription drug plan, flexible spending accounts, health savings accounts, vision, dental, and voluntary short-term and long-term disability coverage.
Bilingual Telephonic Nurse Case Manager Athens AdministratorsBilingual Telephonic Nurse Case ManagerSan Antonio, TexasATHENS POSITION DETAILS Position Title: Telephonic Nurse Case Manager Department: Managed Care Reports To: Case Management Supervisor FLSA Status: Exempt Job Grade: 14 ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. May be requested to attend doctor and/or attorney visits, hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy as deemed necessary.
RN Clinical Reviewer (Proofer) Greenlife Healthcare StaffingRN Clinical Reviewer (Proofer)Jericho, NYGreenlife Healthcare Staffing is seeking a meticulous Clinical Reviewer Proofer Registered Nurse who will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.
RN Clinical Reviewer / IDR Greenlife Healthcare StaffingRN Clinical Reviewer / IDRJericho, NYRemoteGreenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a remote position at a Non-profit organization located in New York. Soft Skills: Excellent written/verbal communication; ability to work independently; flexible and innovative; meets deadlines in sensitive environments; strong collaborative and problem-solving skills.
CERTIFIED NURSE MIDWIFE SU Clinica FamiliarCERTIFIED NURSE MIDWIFEHarlingen, TXThis position requires an initial N95 mask fit testing and annual test fitting thereafter unless there is a significant change during the year that requires retesting prior to the annual fit testing. Supports timely identification, escalation, and transfer coordination for obstetric red flags, including severe hypertension in pregnancy, postpartum warning signs, abnormal fetal assessment concerns, and other urgent maternal safety issues.
Registered Nurse, Care Manager Care New England Health SystemRegistered Nurse, Care ManagerWarwick, RICare New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation's top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. The RN Care Manager works with the patient health care teams to assess patients transition/discharge planning needs, actively prevent unnecessary admissions/readmissions, and facilitate timely transitions/discharges.
Registered Nurse Clinical Reviewer (IDR) Greenlife Healthcare StaffingRegistered Nurse Clinical Reviewer (IDR)Jericho, New York$60Key Responsibilities: Conduct reviews up to and including the appeal level — chart screens, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations. Serve as a resource to administrative and clinical staff for training, problem-solving, and clarifying determinations; provide technical assistance and participate in staff huddles.
NewRegistered Nurse - Infusion Services $128 - Must have AK License to Submit Ambe Healthcare StaffingRegistered Nurse - Infusion Services $128 - Must have AK License to SubmitSitka, AKJob Description: MUST HAVE CURRENT ALASKA LICENSEREQURED EXPERIENCE - Minimum 1 year in immunotherapy/chemotherapy specialty medicationsMust have Flu VaccineStart date will be no less than 6 weeks after traveler's fingerprint cards are received at SEARHC in Juneau for processing. Prepares for infusion patients prior to administration (i.e., reviews orders, effectively communicate with referring physician, oncologist, and pharmacy)Develops and participates in educating patients and their families about post-discharge care programs.
NewAppeals Nurse AxelonAppeals NurseVarious, IARemoteAbility to thrive in a fast-paced environment with frequently changing workloads. Work Mode: 100% Remote, possible on-site if hired full-time.
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RN Care Manager Emergency Room - Per Diem Days MLK Community HospitalRN Care Manager Emergency Room - Per Diem DaysLos Angeles, CAb'nnnnnnnnnnnnnn nnnnnnnnnnnnnnnnrnrnrnrnrnrnrnrnnnnnrnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnrnrnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nnnnnnnttttnttnttnttntttntttnttttnnnnnnnnnnnnnnnnnnnnnttnnnnnnnnnnnn');nnnnnnnnnnnnnnnnnnnnnnnnnnnnnt. ntttttttttttnttttttttttttnttttttttttttntttttttttttttnttttttttttttttntttttttttttttttApply Nownttttttttttttttnnttttttttttttttntttttttttttttnnttttttttttttnntttttttttttntntttttttttt ntttttttttnnttttttttnnttttttttnttttttttntttttttttnttttttttttnttttttttttnnttttttttttnttttttttttt.
RN Case Manager Integris Health IncRN Case ManagerOklahoma City, OKRN (Registered Nurse) Current licensure as a Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state. This job requires the incumbents to operate a INTEGRIS-owned vehicle OR personal vehicle (non INTEGRIS-owned) and therefore must have a current Oklahoma State Drivers License as well as a driving record which is acceptable to our insurance carrier.
NewTravel Nurse RN - Emergency Room (ER) / Trauma - $2,273 per week in Bronx, NY Cynet HealthTravel Nurse RN - Emergency Room (ER) / Trauma - $2,273 per week in Bronx, NYBronx, NY$2,273.42Job Title: Care Manager Profession: Nurse Specialty: Care Management Duration: 14 Shift: 10:00 AM - 6:00 PM Hours per Shift: 35 Experience: Five years minimum of clinical experience as a Registered Nurse License: RN Licensed as a Registered Nurse in the State of New York Certifications: BLS, PRI and Screen certification within three months of employment Must-Have: Care Coordination, Utilization Review, Discharge Planning, Computer Literacy, Leadership Description: Experience with Care Coordination is required. Primary Source Verification of License and Registration as a Registered Professional Nurse is required.
RN Case Manager - Enid Bass Integris Health IncRN Case Manager - Enid BassEnid, OKActs as a resource and provides education for patients, their family members and all health care professionals regarding HCFA regulations, Medicare, Medicaid, managed care and other payers. RN (Registered Nurse) Current licensure as a Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state.