Nurse Reviewer I - Washington, DC

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. · They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of ...

We are hiring a Utilization Review Nurse to support our Utilization Review team by evaluating medical necessity requests and reviewing ongoing hospital stays. · ...

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. · This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy.Nurse ...

+This nurse will support our Utilization Review team by evaluating medical necessity requests and reviewing ongoing hospital stays to ensure services are clinically appropriate, cost-effective, and aligned with plan guidelines. · + ...

We are seeking a licensed RN for a full-time salaried position in medical record review. The role involves coordinating case reviews with administrative staff and physician peer reviewers. · Collaborate telephonically and electronically with industry professionals. · Summarize an ...

Johns Hopkins Health Plans is the managed care and health services business of Johns Hopkins Medicine. We are seeking a Utilization Review Registered Nurse to work from home, monitor the appropriateness of care received by plan members in various settings, evaluate member benefit ...

Navigate and work within our proprietary electronic medical record system to evaluate and process patient health information to determine outcomes for various types of medical and specialty exams · Conduct a clinical review of a variety of examination documentation test results a ...

We are seeking an experienced Remote Quality Review Registered Nurse to join our team supporting military communities. · ...

The Utilization Review Nurse is responsible for reviewing and evaluating clinical information and documentation. · Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations. · Evaluates documentation/information to ...

Zimmerman Associates, Inc. (ZAI) seeks Licensed Practical Nurse Referral Reviewers for its contract with the Integrated Referral Management and Appointing Center (IRMAC). · ...

As a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you have the opportunity to use your clinical skills to make a difference in our members' lives. · ...

Job summary · Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. · ResponsibilitiesConducts admission concurrent and retrospective case reviews to meet hospital objecti ...

This position involves reviewing Medicare Fee-for-Service claims to assess overpayments underpayments and proper payments as determined by Recovery Audit Contractors RACs.RVC Reviewers perform automated and complex reviews of claims including Part A B DMEPOS and Home Health Hospi ...

The Nurse Educator/Review Coordinator's primary role is to facilitate provider education related to the claim reviews performed under Task Order 3 for the BFCC-QIO contract. · ...

Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. · ...

Make it happen at Hopkins As a member of Johns Hopkins Medicine, Johns Hopkins Howard County Medical Center is a 266-bed acute care facility that has been serving the community for nearly 40 years. We can offer the most advanced, innovative technology with the collaboration and t ...

The Nurse Educator/Review Coordinator's primary role is to facilitate provider education related to the claim reviews performed under Task Order 3 for the BFCC-QIO contract. · Graduation from an accredited school of nursing and current licensure as Registered Nurse (RN) or accred ...

Come join a company that strives for Extraordinary People and Exceptional Performance. Chenega Supply Chain Solutions (CSCS) is looking for a Nurse Practitioner-Contract Medical Reviewer (CMR) to support the Department of Health and Human Services (HHS), within the Health Systems ...

This position is an Evergreen position which is a continuous need within our organization. Come join a company that strives for Extraordinary People and Exceptional Performance. Our company offers employees the opportunity to join a team where there is a robust employee benefits ...

Nurse Practitioner-Contract Medical Reviewer for Chenega Corporation to support the Department of Health and Human Services. Ideal candidates bring 5+ years of recent clinical experience in outpatient medicine.Serve as Contract Medical Reviewers. · Contribute to the enhancement o ...