Senior UM Review Nurse - Remote

We're hiring a Utilization Review Nurse to join our Utilization Review team. You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. · Complete medical necessity reviews and level of care reviews for requested ser ...

+We're committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you're excited about this position, we encourage you to apply – even if your experience doesn't match every requirement. · The Pre-Certification Review Nurse – Pharmacy is respon ...

We're excited you're considering an opportunity with us. Responsible for working in collaboration with the Medical Director on driving the decrease in care variance, to ensure timely discharges, and to refer members to other plan resources to meet their care conditions. · ...

The RN Senior Medical Reviewer provides advanced medical review expertise and supports oversight of the medical review process, focusing on complex services and quality assurance. · ...

We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. · Review medically complex claims, pre-authorization reque ...

We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. · Review medically complex claims and pre-authorization requests. · Evaluate medical necessity and appropriateness for coverage and reimbursement. · Provide clear rationales for service approvals or ...

The RN Senior Medical Reviewer provides advanced medical review expertise and supports oversight of the medical review process. · ...

The Clinical Documentation Integrity Specialist will review inpatient medical records for completeness and accuracy. ...

We seek a Clinical Education Consultant to design realistic clinical scenarios for our interactive learning platform. · Collaborate with educators to develop simulation cases. · Ensure content aligns with nursing competencies. · ...

+Job summary · Are you a skilled, compassionate nurse looking for flexible work in clinical research? · +Deliver competent, high-quality nursing care to study patients in their homes. · Accountable for the competent and confident delivery of high-quality clinical care to patients ...

Are you a skilled, compassionate nurse looking for flexible work in clinical research? · ...

++Are you a skilled, compassionate nurse looking for flexible work in clinical research? · +As a Clinical Research Nurse – Home Visits (PRN), you’ll provide high-quality nursing care directly in patients’ homes while supporting important research studies. · ++Deliver competent, h ...

Are you a skilled nurse looking for flexible work in clinical research? · We are seeking a Clinical Research Nurse – Home Visits (PRN) to provide high-quality nursing care directly in patients' homes while supporting important research studies. · ...

Are you a skilled compassionate nurse looking for flexible work in clinical research? · You will provide high-quality nursing care directly in patients homes while supporting important research studies.This role is ideal for nurses who value flexibility independence enjoy local t ...

We transform challenges into opportunities with expert program management,cutting-edge technology,and innovative consulting solutions. · Performs medical claim reviews for one or more of the following:claims for medically complex services,services that require preauthorization/pr ...

The Medical Review (MR) Manager oversees all medical review activities and quality assurance functions for the CMS Review and Validation Contractor (RVC) program. · Minimum of 5 years of medical review experience. · ...

We are looking for LPN/LVN Content Editors to contribute to the continued development of our nursing and NCLEX products. · Writing and editing content; · ...

The Prior Authorization Clinician is responsible for reviewing all proposed hospitalization services for medical necessity to ensure members receive appropriate care. · We are committed to diversity and inclusion of staff among our employees. ...

Are you a skilled compassionate nurse looking for flexible work in clinical research? As a Clinical Research Nurse – Home Visits (PRN) you'll provide high-quality nursing care directly in patients' homes while supporting important research studies. · ...

Provide support and success strategies through one-on-one mentoring and group webinars,to pre-licensure nursing students. · Provide academic support to students by reviewing best practices in study skills... · ...