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PRN Utilization Review Nurse Reviewer
Dane Street, LLC
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,…
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Clinical Quality Assurance Coordinator (33175)
IME RESOURCES LLC
Before applying, please note that this role is open exclusively to RN, LPN or LVN.
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Grievance & Appeals Nurse
Centene Management Company LLC
LPN or LVN with 3+ years of clinical nursing experience or RN with 2+ years of clinical nursing experience. Experience with utilization or appeals review preferred. Knowledge of InterQual…
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Transition of Care Associate - Remote
CVS Health
Our TOC Coaches are frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and…
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Inpatient Review Nurse (LVN or RN)
Medix Staffing Solutions
Utilization Management Nurse (RN/LVN) – Inpatient Review
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Utilization Management Nurse - Remote
Astrana Health, Inc.
Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny…
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Case Review Manager – Independent Reviews (IRO/UR)
Rediminds, Inc.
Hands-on experience in utilization review (UR), healthcare appeals, independent review, clinical review operations, or closely related medical-record and decision-document quality assurance.
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Nurse - Clinical Review
WNS Global Services
The Clinical Review Nurse makes prospective medical necessity determinations on prior authorization requests for HealthHelp’s specialty programs, including Diagnostic Imaging, Cardiology,…
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Nurse Team Lead - Clin Rev
WNS Global Services
The Clinical Review Team Lead is the team’s clinical subject matter expert for prospective utilization review. The Team Lead resolves complex criteria and guideline questions, audits and…
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UM Outpatient Review Nurse
All Care To You
The position of UM Outpatient Review Nurse reports to the Director, Case Management. The position of UM Outpatient Review Nurse is part of the Case Management team and is responsible for…
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Prior Authorization Nurse
Medix Staffing Solutions
Our client is seeking a dedicated Prior Authorization Nurse to ensure timely completion of prior authorization requests in compliance with contractual and evidence-based standards. This…
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PRN Utilization Review Nurse Reviewer
Dane Street, LLC
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,…
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Senior Provider Education Consultant - (LPN, RN)
Palmetto GBA
Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone…
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Consultant, Sr Provider Education
Palmetto GBA
Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone…
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Quality Improvement Coordinator II
Centene Management Company LLC
Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related…
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