RN: Clinical Review & Medical Policy Analyst
Jobtailor
Jobtailor is seeking a registered nurse with utilization review experience to review complex medical claims and interpret medical policy for government-related programs in the United States. The role emphasizes clear articulation of health information and adherence to policy standards. Requirements include an active RN license and at least 3 years of clinical experience. The position operates during EST business hours, with background checks and vaccination considerations as part of the #J-18808-Ljbffr Jobtailor
$29 - $52 per hour
...Connecting. Growing together. The Clinical Claim Review RN will be responsible for... ...compliance reviews of medical and administrative documentation... ...and federal compliance policies, reimbursement policies, and... ...Sr. Recovery Resolution Analyst will present and discuss audit...MedicalHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaRemote workMonday to FridayShift work- Optum Insight is seeking a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation to identify fraud or wasteful practices. The role involves site visits, desk audits, and collaboration with a team of auditors to document findings...MedicalRemote jobFull timeLocal area
$28.37 - $39.19 per hour
...outcomes through technology, services, and clinical expertise. Our mission is to innovate... ...Acentra Health is looking for a Clinical Reviewer-RN to join our growing team. Job Summary:... ...The purpose of this position is to review medical records against appropriate criteria in...MedicalContract workLocal areaFlexible hours$2,221 - $2,374 per week
...Registered Nurse (RN) | Outpatient Clinic Location: Brooklyn, NY Agency: Host Healthcare... ...Satisfaction by MIT Sloan Management Review. No matter if you want to explore the... ...every major healthcare system · Day-1 medical benefits that last up to 30 days between...MedicalFull timeContract workLocal areaImmediate startShift work- Maximus is seeking a Clinical Nurse Consultant to join the Federal Exchange Review Process (FERP) team in a remote capacity. You will manage end-to-end medical reviews, ensure accurate assessments, and coordinate... .... The role requires a valid RN or LPN license, experience with...MedicalRemote jobMonday to Friday
- Review and make complex medical determinations about whether claims meet the member's... ...valid claims using medical policy Comprehend medical policy and... ...and minimum of 3 years of clinical experience, or an equivalent... ...Current unrestricted RN license required Applicants...MedicalMonday to Friday
- ...re looking for US-credentialed clinical professionals to support a... ...use your clinical expertise to review and interpret de-identified electronic... ...and accurately annotate medical information. Normalize clinical... ...Registered Nurse (RN), Nurse Practitioner (NP), or...MedicalRemote jobFor contractors
$43 per hour
...pediatricians, nurse practitioners, and clinical support staff practices a... ...-oriented Registered Nurse (RN) to join our Jersey City... ...tests, administer PO medications, blood draws, and assistance... ...labs and medical inquiries. Review and address diagnostic testing...MedicalFull timeTemporary workPrivate practice- Albany Medical College seeks an experienced RN for ambulatory General Surgery at 50 New Scotland Avenue, Albany... ...patient care in a busy surgery clinic and performs triage, assessment and... ...administers meds, assists with procedures, reviews test results, and educates patients...Medical
- MarinHealth is seeking a Utilization Review Nurse II to perform admission, concurrent and... ...Health Records. In this role you will assess clinical stability, coordinate transfers for... ...with a multidisciplinary team to ensure medical necessity #J-18808-Ljbffr Marin General...Medical
- ...issues with innovative policies and programs and... ...The Senior Policy Analyst will work under the direction... ...health data, including clinical, surveillance, and programmatic... .... Research, review, and summarize current... ...package including Medical, Dental and Vision....MedicalTemporary workWork at officeLocal areaMonday to FridayFlexible hours
- UnitedHealth Group is seeking an Utilization Management & Clinical Validation RN to accurately review medical records and extract case details, crafting... ...telecommuting options, adhering to HIPAA and company policies while supporting enterprise goals and client relationships...MedicalRemote jobFlexible hours
- UnitedHealth Group is seeking a Clinical Claim Review RN in Massachusetts for full-time remote work. The role involves performing compliance reviews of medical and administrative documentation to identify fraud, waste, or abuse, using claims data, audits, and investigations...MedicalRemote jobFull timeLocal areaShift work
$23.76 - $51.49 per hour
...Summary Provides support for clinical member services review assessment processes.... ...verifying that services are medically necessary and align with established... ...guidelines, insurance policies, and regulations - ensuring... .... Registered Nurse (RN). License must be active and...MedicalRemote jobHourly payWork experience placementWork at office- Registered Nurse (RN) - Infusion Clinic (Full-Time, 4 10hr shifts)# Registered Nurse (RN) - Infusion... ...education. Washington Regional Medical System is a community-owned, locally governed... ...and/or examinations, as needed* Review clinic orders and ensure all necessary...MedicalFull timeLive inWork at officeShift work
- ...Nurse with an OH or compact license to join the Care Review Clinician team. You will provide prior authorization for... .... Key responsibilities include reviewing requests for clinical necessity, collaborating with medical directors, and ensuring compliance with state and...MedicalMonday to Friday
- TCHP Clinical Navigator-RN - Redbank Medical Oncology - Full Time - Days OH, United States Job Description The Clinical Nurse Navigator uses their oncology... ...management interventions. Participate in self and peer review activities to include the positive recognition of peers...MedicalFull timeInterim roleWork at officeFlexible hoursShift work
- ## RN Outpatient Specialty | ENT & Lung ClinicApplyremote type:... ...Excellence.Join our dynamic ENT & Lung Clinic team in Kalispell, MT!This PRN... ...* Rooming patients, obtaining medical history* Perform vitals, blood... ...during visit.* Independently reviews medication lists and provides...MedicalFull timeReliefWork at officeImmediate startMonday to FridayShift workWeekend workDay shift
$60.2k - $107.4k
...together. The Utilization Management & Clinical Validation RN will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly... ...functions, adhering to both Optum and OPAS policies and procedures, which include but...MedicalMinimum wageFull timeWork experience placementLocal areaRemote work- ## RN - Clinic UrologyApplylocations: Physician Office Centertime type... ...through observation and chart review to facilitate appropriate... ...65 WVUH Urology**Address:**1 Medical Center DriveMorgantownWest Virginia... ...discrimination. This policy applies to all terms and conditions...MedicalPermanent employmentTemporary workWork at officeLocal areaShift work
- ...assigned patients. Executes medical plan of care, at the... ...outcomes reporting, clinical audits, and programmatic... ...prescription refills for Provider review and approval. Nurses... ...: Current NY State RN License required.... ...employer, it is our policy to provide equal...MedicalHourly payContract workWork at officeLocal areaImmediate startFlexible hours
- ## Utilization Review RN II, Care Coordination, Full-Time, DaysApplylocations: Greenbrae,... ...North Bay. With a world-class physician and clinical team, an affiliation with UCSF Health,... .... MarinHealth comprises MarinHealth Medical Center, a 327-bed hospital in Greenbrae,...MedicalFull timeWork at officeLocal areaShift work
$36 - $59.4 per hour
## RN, Primary Care Clark/Deming ClinicApplylocations: Lincoln... ...latest benefits and innovations in medical technology, research and... ...for an interview.Primary Care Clinic hours are 8am to 5 pm.Position... ...position. Ranges are regularly reviewed to stay aligned with market conditions...MedicalHourly payFull timePart timeWork at officeVisa sponsorshipShift work- ## RN Utilization ReviewApplylocations: Louisville... ...five hospitals, four medical centers, nearly 200 physician... ...** The Utilization Review RN performs activities... ...not limited to making clinical recommendations regarding... ...established criteria, policies, and UM leadership oversight...MedicalWork at officeShift work
$92k - $95k
...Make a difference every day as an Amedisys RN clinical manager Join Amedisys-one of the largest... ...'s in it for you Choice of PPO or HSA medical plans with free telehealth. Paid time... ...clinical operations for the care center. Reviews requests for services and determines...MedicalFull timeImmediate startShift work- ## RN Peer Review & Performance Improvement CoordinatorApplylocations:... ...system with five hospitals, four medical centers, nearly 200... ...of care and development of policies and procedures • Assists with... ...acute care, hospital-based clinical experience in area of intended...MedicalShift workDay shift
- Job Summary and Responsibilities As a Clinical Documentation Specialist, you will provide critical expertise in medical record accuracy and integrity, profoundly impacting... ...financial compliance. Every day you will expertly review clinical documentation, query physicians for...Medical
- ...action. POSITION SUMMARY The RN Clinical Trainer supports the mission... ...of clinical competencies for Medical Assistants (MAs), Licensed Practical... ..., workflow standardization, policy implementation, and... ...required to assess patients, review medical information, and communicate...MedicalLocal area
- Personify Health is hiring an LVN-licensed reviewer to assess outpatient, inpatient, and mental health pre-certifications for medical appropriateness and necessity. You will also drive post-service reviews to verify medical necessity, escalate complex cases, and coordinate...Medical
- ## RN Clinical Team Specialist | Homecare Home Base | OASISApplylocations: Saginaw - MItime... ...the individualized patient plan of care.* Reviews and approves plan of care and evaluates... ...employees* Comprehensive insurance plans for medical, dental, and vision benefits* 401(K)...MedicalFull timeWork at officeFlexible hours
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