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Focused on auditing outpatient and specialty claims, the full-time Clinical Auditor RN will utilize coding and clinical chart validation expertise to ensure accuracy, medical necessity, and appropriateness of services delivered, while working in a...

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An Infusion Nurse II is a licensed registered nurse who coordinates and provides intermediate direct patient care to patients in the home, or in an alternate infusion suite, to ensure patient safety with continuity and compliance under a physicians...

As a Registered Nurse (RN), you will be a pivotal healthcare professional, delivering compassionate, high-quality care that truly impacts our patients' well-being and recovery. Every day, you will leverage your expertise to provide individualized,...

Ssbv Clinical Claims Review Rn Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting...

Job Description Pre-Authorization RN Compensation Salary Range: $90,000 - $108,000 per year Bonus / Commission (if applicable): This role is eligible...

Overview Performs inpatient chart review to determine appropriate DRG assignment and assures appropriate documentation in the chart to support clinical care provided, including severity of illness and risk of mortality which...

Behavioral Health Case Manager Responsible for providing telephonic and e-referral case review and authorization of services utilizing established mental health and substance abuse medical necessity criteria to provide quality care...

Overview The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in...

As an integral part of the interdisciplinary team, the Registered Nurse utilizes the nursing process to provide therapeutic care to patients. Provides nursing care in accordance with departmental policies and procedures and established standards of...

Utilization Management Registered Nurse The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration...

Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse - Work from Home! Get AI-powered advice on this job and more exclusive features.Direct message the job poster from BroadPathGlobal Talent Attraction...

Emory Healthcare Utilization Review Specialist Be inspired. Be rewarded. Belong. At Emory Healthcare. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership...

The CTRC is a research environment that cares for research participants on clinical trials. The clinical trials may be phase I trials, gene therapy, radioligand investigational products or investigational devices. The CTRC nurse practitioner will...

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...

We are recruiting for a mission-driven RN Educator, Clinical Documentation Integrity - Must Reside in Colorado to join our team! We're with you for life's journey. At Denver Health, purpose isn't just something we believe in-it's something...

Post-Discharge Patient Outreach Coordinator Inspire health. Serve with compassion. Be the difference. Responsibility for initiating phone contact with discharged patients from specified units, conducting query on patient experience...

Deliver direct patient care in an outpatient dialysis setting. Monitor patients, manage treatment plans, and respond to health changes. Collaborate with a supportive clinical team, including Patient Care Technicians. Educate patients and families on...

Responsible for the delivery of patient care through the nursing process of assessment, diagnosing, planning, implementation and evaluation. Responsible for directing and coordinating all nursing care based on established clinical nursing care for...

Working remotely in a full-time capacity, the Registered Nurse Clinical Auditor will conduct clinical audits and reviews related to fraud, waste, and abuse, analyzing care services, coding requirements, and resource utilization while collaborating...

Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical...

CD RN (Clinical Documentation Specialist)-Level 2 Johns Hopkins Intrastaff is the internal staffing agency for the Johns Hopkins Health System and partner hospitals, providing temporary support to a variety of the Johns Hopkins locations.

RN Clinical Reviewer / IDR - Remote (#25310C) Location: Remote Employment Type: Full-time Hourly Rate: $50/hr...

Job Description RN Utilization Review - Remote. This position is Per Diem and will work 8-hour, Day shifts. Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA...

Direct Jobs seeks a dedicated RN Navigator for Infectious Disease Transition Services to manage outpatient parenteral therapy and complex antimicrobial treatments. The role emphasizes collaboration with physicians and care teams to ensure safe...