Utilization Review Nurse - Richardson, TX

We're seeking a detail-oriented and experienced Registered Nurse (RN) to join our Medical Review team. · In this role, you will use medically accepted clinical criteria to assess the medical necessity and appropriateness of treatment plans. · ...

Registered Nurse (RN) working in insurance industry using medically accepted criteria to validate medical necessity. · Perform accurate and timely medical review of claims suspended for medical necessity. · Initiate and/or respond to correspondence from providers or members conce ...

The Utilization Review Nurse performs accurate and timely medical reviews of claims suspended for medical necessity using medically accepted criteria. · RN working in insurance or managed care industry. · Awareness of claims processes and health insurance legislation. · ...

RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. · ...

This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services. · ...

Review Workers Compensation requests submitted by the provider, requestor, claimant or carrier to determine the medical necessity of the treatment utilizing clinical expertise and evidence-based treatment guidelines. · Perform an evaluation of the medical data for utilization rev ...

This is a contract assignment that will start right away and end on April 30th 2024. Review Nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey. · ...

Nurse Reviewer I is responsible for conducting preauthorization, out-of-network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. · ...

Nurse reviewer I conducts preauthorization and reviews of diagnostic imaging services by utilizing appropriate policies and clinical guidelines. · ...

This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services. · ...

+Job summary · We're seeking an experienced Registered Nurse to join our team in Dublin, OH. As a Pre-Certification Review Nurse - Pharmacy, you will review and process coverage determinations and utilization management reviews for specialty medications. · +ResponsibilitiesReview ...

Utilization Review Nurse · The ideal candidate will have 3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company. · Knowledge of medical terminology and procedures · ...

The Pre-Certification Review Nurse – Pharmacy is responsible for reviewing and processing coverage determinations and utilization management reviews for specialty medications. · We believe that no one should have to navigate the cost and complexity of healthcare alone, · ...

We are seeking a dedicated Registered Nurse Navigator for Home Health Review - Health Admin in Irving TX. · Review and validate home health documentation for accuracy and compliance. · Coordinate with interdisciplinary teams to ensure quality care delivery. · Conduct assessments ...

The RN Navigator Home Health Review monitors home health patients to ensure patients continue to meet the CMS criteria for services.They are a member of the patient's care team and act as a patient advocate, providing proactive outreach to CHRISTUS Health value-based payer patien ...

We are seeking a dedicated Registered Nurse Navigator for Home Health Review - Health Admin in Irving, TX. · Review and validate home health documentation for accuracy and compliance. · Coordinate with interdisciplinary teams to ensure quality care delivery. · ...

The RN Navigator Home Health Review monitors home health patients to ensure patients continue to meet the CMS criteria for services. · ...

The RN Navigator Home Health Review monitors home health patients to ensure patients continue to meet the CMS criteria for services. · ...

+The RN Navigator Home Health Review monitors home health patients to ensure patients continue to meet the CMS criteria for services. · ++Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. · '+ 'Stays abreast of ...

Job summary · The RN Navigator Home Health Review monitors home health patients to ensure patients continue to meet the CMS criteria for services. They are a member of the patient's care team and act as a patient advocate, providing proactive outreach to CHRISTUS Health value-bas ...