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A company is looking for a Clinical Review Nurse - Correspondence.Key ResponsibilitiesDrafts correspondence letters based on clinical review outcomes in accordance with NCQA standardsInvestigates denials and provides supplemental information to...

A company is looking for a Nurse Case Manager (WC and PIP).Key ResponsibilitiesNegotiate fees and coordinate referrals with rehabilitation and medical case management vendorsGather, analyze, and report service data significant to clients and...

A company is looking for a Call Center Nurse RN, HouseCalls - Remote.Key ResponsibilitiesPerform telephonic outreach to members for follow-up post HouseCalls visitEnsure members have scheduled appointments with their Primary Care Provider and...

A company is looking for a Clinical File Review Specialist (RN) to support physician reviewers by analyzing complex medical records in a remote, non-patient-facing role.Key ResponsibilitiesReview medical records for disability, workers'...

A company is looking for a Utilization Management Nurse.Key ResponsibilitiesCoordinate and facilitate correct identification of patient statusConduct concurrent and retrospective reviews and support the medical necessity denial and appeal...