Medical Review Nurse - AZ, United States

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. · ...

Provide clinical review of medical claims and post service appeals. Facilitate appropriate investigation of issues and management of medical services and benefits administration while maintaining SCAN timeframe standards. · ...

+Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. · ...

We seek Rebels who are curious about AI and its power to transform how we operate and serve our members. · Actively support the achievement of SCAN's Vision and Goals. · Clinical review of medical claims and post service appeals. · ...

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the "12 Angry Seniors". Their mission cont ...

Utilization Review Nurse Procedural Terminology coding and billing · Determine Medical Necessity per Evidence-Based Guidelines disease management plan of care utilise InterQual Criteria concurrent review continued stay reviews CPT (Current Procedural Terminology) coding and bill ...

This Utilization Review Nurse position involves reviewing patient admissions to ensure medical necessity and adherence to evidence-based guidelines. · ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy. · Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessi ...

The Nurse Reviewer is responsible for conducting preauthorization reviews for diagnostic imaging services by utilizing appropriate policies and clinical guidelines. · Collaborates with healthcare providers and members to promote the most appropriate use of diagnostic imaging. · W ...

Provides expertise to the organization in the form of quality management review and performance improvement knowledge. Supports the hospital and medical staff in Performance Improvement activities and works within the organization's Performance Improvement plan. · ...

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. · ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy. The nurse reviewer I will be responsible for conducting preauthorization reviews for diagnostic imaging services by utilizing appropriate policies and clinical guidelines. · Collaborat ...

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist their Health Services Department. · ...

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. · ...

+We are currently seeking a Registered Nurse with 2 to 3 years of clinical nursing background and 2 to 3 years of Utilization Review experience. · +Liaise with providers/staff · + ...

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. · ...

This role enables associates to work virtually full-time with the exception of required in-person training sessions providing maximum flexibility and autonomy. · ...

We are looking for an experienced CA-licensed Utilization Review Nurse to assist our Health Services Department. The nurse will utilize their clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria. · ...

The Nurse Reviewer is responsible for conducting preauthorization reviews for diagnostic imaging services by utilizing appropriate policies and clinical guidelines.Conducts initial medical necessity review of exception preauthorization requests for services requested outside of t ...

This role enables associates to work virtually full-time, except for required in-person training sessions. · Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medi ...