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Performing pre-service clinical coverage review of services (predetermination reviews), using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria. Managing clinical Out of...

JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

A leading healthcare provider in Winston-Salem is seeking a Telehealth Nurse to provide nursing services remotely. Applicants should have a valid RN license and at least 3 years of clinical experience, preferably in telephone triage. Strong...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

A state government agency in Florida is seeking a Registered Nurse Specialist to support foster children with complex medical needs. The role involves conducting assessments, home visits, and collaborating with caregivers and healthcare teams.

A leading healthcare organization is looking for a Nurse Reviewer I to conduct preauthorization and appropriateness of treatment reviews for diagnostic imaging services. The role supports remote work and requires an associate degree in nursing...

Remote position, however, candidates must reside in the State of TX or State of IL. This position is a contract for about 9 months. Pay: $41/hour Job Responsibilities: RN working in the insurance or managed...

We believe everyone should have confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and management of their health through continuous care...

JOB DESCRIPTION Job Summary The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Nurse Navigator 1 - Site Disease - Full Time/Remote page is loaded## Nurse Navigator 1 - Site Disease - Full Time/Remotelocations: Miami, FLtime type: Full timeposted on: Posted Todayjob requisition id: R100091779## **Current Employees:**If you...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Clinical Claims Review At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.

Non State Tested Nursing Assistant First Community Village located in Columbus, OH is an independent living, assisted living and memory care community with a team of health care professionals that is unmatched in the area! We...

Medical Review Nurse The Medical Review Nurse provides support for medical claim and internal appeals review activities ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and...

Remote position, however, candidates must reside in the State of TX or State of IL. This position is a contract for about 9 months. Pay: $41/hour Job Responsibilities: RN working in the insurance or managed...

Vetted is seeking a RN - Correctional for a travel job in Orient, Ohio. The job was posted about 24 hours ago. The assignment starts on ASAP and is 13 weeks long with 8 hour shifts 5 days a week.You must live 60 miles away from the facility in order...

We are so glad you are interested in joining Sutter Health! Organization: SHSO-Population Health Services-Utah Position Overview: Aids patients in obtaining the correct level of care with...

Schedule: Part-time, either 3 (10 hour) shifts or 4 (8 hour) shifts. Day/pm hours available. Every third weekend and holiday rotation. - - Candidate MUST have 2 years' acute care experience (ED, Urgent Care, ICU and some Med/ Surg will be...

What You'll Do... * Administers medication (e.g., oral intramuscular and intravenous) and monitors patient medication compliance * Performs treatments and performs or assists with nurse's sick call * Assists with doctor's sick call...

Join to apply for the RN Call Assist Remote in PST role at Optum 1 day ago Be among the first 25 applicants Join to apply for the RN Call Assist Remote in PST role at...

A prominent medical institution is seeking a Nurse Rev II to conduct clinical assessments and evaluations for individuals in nursing facilities. This hybrid role includes statewide travel and offers flexible scheduling with no weekends or...