- Point32Health (MA)
- …day in service to our members, partners, colleagues and communities. **Job Summary** The Clinical Reviewer is a licensed Registered Nurse that is expected to ... Precertification Team Manager or department Manager. The Clinical Reviewer is expected to demonstrate the ability to work...the job** + Bachelor's degree in Nursing preferred + Registered Nurse with a current and unrestricted… more
- US Tech Solutions (Canton, MA)
- … license required.** + The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is expected to function independently in her / ... Precertification Team Manager or department Manager. The Clinical Reviewer is expected to demonstrate the ability to work...& License:** + Bachelor's degree in Nursing, preferred + Registered Nurse with current a and unrestricted… more
- Katmai (Usaf Academy, CO)
- …enrollees identified as having the need for inpatient/ outpatient precertification . **ESSENTIAL DUTIES &** **RESPONSIBILITIES** + Review precertification ... the Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...+ Must possess a current, active, full, and unrestricted Registered Nurses ( RN ) licensed in Colorado, be… more
- Surgery Care Affiliates (Jacksonville, FL)
- …in areas of treatment plan, discount or per diem negotiations, precertification concurrent reviews and timely reports. + Determines tentative initial discharge ... of discharge plan by assisting with arrangements for family education, equipment, outpatient therapy, and other services as appropriate for patient discharge level… more
- Covenant Health Inc. (Knoxville, TN)
- …recent utilization management or case management experience. Licensure Requirements: Current licensure as a Registered Nurse ( RN ) as issued by the State of ... Overview Registered Nurse , Revenue Integrity & Utilization...staff activities. + Provides advice and counsel to non-clinical precertification staff. + Assists with delayed claims review… more
- Houston Methodist (Baytown, TX)
- …performance that demonstrates progressive leadership abilities **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure ... + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and Appeals. Collaborates...and/or Compact State Licensure within 60 days **OR** + RN -Temp - Registered Nurse -… more
- Hackensack Meridian Health (Hackensack, NJ)
- …by insurance payers to convey and communicate to clinical care givers (Physicians, Nurse Practitioners and RN case managers. + Ability to deal effectively ... coordinating all the functions and activities related to patient precertification /authorization for Chemotherapy, Radiation, and Diagnostic Imaging associated with a… more