RN Utilization Review & Medical Appeals Specialist
$29.05 - $67.97 per hourMolina Healthcare of Illinois
Molina Healthcare in Detroit, Michigan, seeks a clinical reviewer responsible for evaluating medical necessity and coding compliance in the utilization management process. Candidates must hold an active RN license and have at least 2 years of clinical nursing experience, including substantial work in utilization review. The position demands strong analytical and communication skills, and offers a competitive benefits package. Pay ranges from $29.05 to $67.97 HOURLY based on experience and location. #J-18808-Ljbffr Molina Healthcare
$29.05 - $67.97 per hour
...Description Job Summary Utilizing clinical knowledge... ..., responsible for review of documentation to ensure medical necessity and... ...concurrent review of appeals for denied prior authorizations... ...Registered Nurse (RN). License must be... ...Medical Audit Specialist (CMAS), Certified...SuggestedHourly payWork experience placementWork at office$29.05 - $67.97 per hour
...Description Job Summary Utilizing clinical knowledge... ..., responsible for review of documentation to ensure medical necessity and... ...review of appeals for denied prior authorizations... ...Registered Nurse (RN). License must be... ...Medical Audit Specialist (CMAS), Certified Case...SuggestedHourly payWork experience placementWork at office- ...state of MI unrestricted RN license. You will... ...concurrent and retrospective review of inpatient,... ...ancillary services to ensure medical necessity, appropriate... ...level of care, including appeal requests initiated by... ...unit preferred Prefer utilization management experience...SuggestedWork at officeRemote workFlexible hours
- Strategic Staffing Solutions is seeking a Medicare Advantage RN Review Analyst based in Detroit, MI. This 12+ month W2 contract role requires... .... Responsibilities include approving or rejecting claims and utilizing data systems for clinical reviews. The ideal candidate will...SuggestedRemote jobContract work
- ...policy. Prepare, organize, and efficiently utilize supplies and equipment to prevent wastage.... ...accurately and in a timely manner. Review treatment sheets for completeness, ensure... ...(NOT HOME ASSIST): Assisting the HT RN: May assist HT RN on Home Visit as directed...SuggestedImmediate start
- ...analysis and investigation of authorization requests for specialized medical/surgical/outpatient procedures in an expeditious and accurate... ...and route request for services that require medical review to appropriate team member(s). Facilitate communication with...Full timeShift work
- ...Prepare, organize, and efficiently utilize supplies and equipment to... ...care under the supervision of RN. Staff Related * Assists in training... ...accurate and timely manner. * Review treatment sheets for... ...CPR certification. Fresenius Medical Care maintains a drug-free workplace...Immediate start
- ...Overview The ROI Specialist is responsible for providing remote support at a specified... ...Information (ROI) requests for patient medical record requests* Responsibilities Determines records to be released by reviewing requestor information in accordance with...Work experience placementWork at officeRemote work
- ...Michigan Should have a valid MI RN License Should Have utilization management experience. Should... ...experience completing post-acute reviews for the inpatient rehab, skilled nursing... ...Clinical experience in ICU, ER, or medical surgical unit preferred....Remote work
- ...functions according to department protocols. Utilizes independent judgment in determining... ...additional information about the patient's medical history as necessary. Prepares... ...solutions for administration to patients. Reviews clinical data on requisition, analyzes...Flexible hoursShift work
- ...Prepare, organize, and efficiently utilize supplies and equipment to... ...care under the supervision of RN. Assists patients in performing... ...and timely manner. Review treatment sheets for completeness... ...Liaisons with appropriate FKC staff members Fresenius Medical CareLocal areaImmediate start
- ...Registered Nurse (RN) | Post-Anesthesia Care Unit (PACU) / Pre... ..., MI Agency: Fusion Medical Staffing Pay: Competitive... ...patients pre-operatively, including reviewing medical history, performing... ...to emergency situations utilizing Pre/post op nursing standards...Weekly payFull timeContract workTemporary workShift work
- ...Registered Nurse (RN) | Post-Anesthesia Care Unit (PACU) / Pre... ..., MI Agency: Fusion Medical Staffing Pay: Competitive... ...patients pre-operatively, including reviewing medical history, performing... ...to emergency situations utilizing Pre/post op nursing standards...Weekly payFull timeContract workTemporary workShift work
- ...responsible and trustworthy individuals for the part‑time role of Medical Chart Retrieval Specialist. In this role, you will have the opportunity to visit... ..., confirming appointments and arriving prepared. Utilize our system to confirm and retrieve correct charts, and troubleshoot...Part timeRemote workHome officeMonday to Friday3 days per week
- ...visit Job Title: Ophthalmic Technician / Medical Assistant - PRN Company: Southgate... ...Hep-Locks. Assists in post-op instruction review with patient. Acts under the direct supervision... ...education. Participates in economical utilization of supplies and medication, and ensures...Full timeReliefWork at officeMonday to FridayWeekend work1 day per week
- ...integrates cost, quality and utilization to facilitate the... ...discharge of the patient. Reviews and evaluates... ...continued stay based on medical necessity. The overall... ...revenue cycle, and clinical appeals staff, physicians, and... ...Will consider non-BSN RN if actively pursuing a...Part timeMonday to FridayShift workWeekend work
$15.75 - $18.9 per hour
...Medical Receptionist - Patient Experience Specialist MI - Detroit Sono Bello is America's top cosmetic surgery specialist, with 185+ board-certified surgeons... ...daily close out reports on scheduling system and review for accuracy. Fill deposit slips for all received...Full timeNight shift- ...Washington. Occ Summary The Medical Coder Specialist will have frequent and daily... ...operative reports signed by the provider. Reviews the complex (problematic coding that needs... ...managers/management (PQRS). Collaborate with appeal and edit coders for expedient...Immediate startRemote work
- ...following established policies and procedures, performs diagnostic interventional exams utilizing appropriate imaging equipment. Verifies patient identity and reviews patient's medical record for appropriateness of exam or procedure. Interviews patient to obtain, verify...Part timeRelocation packageShift work
- ...following established policies and procedures, performs diagnostic interventional exams utilizing appropriate imaging equipment. Verifies patient identity and reviews patient's medical record for appropriateness of exam or procedure. Interviews patient to obtain, verify...Full timeRelocation packageShift work
$29 - $38 per hour
...following established policies and procedures, performs diagnostic interventional exams utilizing appropriate imaging equipment. Verifies patient identity and reviews patient’s medical record for appropriateness of exam or procedure. Interviews patient to obtain, verify...Hourly payFull timeRelocation packageFlexible hoursShift work- ...Registered Nurse (RN) Nights Job Category: Nursing Requisition... ...for Fulltime Employees ~ Medical, Guardian Dental and Vision, Benefits... ...Ensures that supplies are utilized economically and that... ...For further information, please review the Know Your Rights notice from...Full timeLocal areaShift workNight shift
$40.4 - $54.77 per hour
...Registered Nurse (RN) Afternoon Job Category: Registered Nurse... ...Package Options? Medical Benefits: Affordable medical insurance... ...in understanding and utilizing your benefit options. Pet Insurance... ...further information, please review the Know Your Rights notice from...Bi-weekly payHourly payWeekly payDaily paidFull timeTemporary workLocal areaFlexible hoursShift work- ...), IBM Job Details Fusion Medical Staffing is seeking a skilled Post/Pre-Op RN for a 13-week travel assignment... ...patients pre-operatively, including reviewing medical history, performing... ...promptly to emergency situations utilizing Pre/post op nursing standards, policies...Temporary workShift work
- ...Effective Date: 6/1/2019 Review Date: NA Position Summary:... ...reported. # Administer prescribed medications, and or start intravenous fluids... ...accredited Registered Nurse (RN) School of Nursing - Diploma... ...familiarity, ability to effectively utilize facility information and...Work experience placementImmediate startShift work
$48 per hour
...Medisource is seeking a local contract nurse RN Case Management for a local contract... ...Duties: • Using clinical tools and data review, conducts comprehensive assessments of referred... ...administration of benefits • Utilizes case management and quality management processes...Hourly payContract workLocal areaMonday to FridayShift work$28.94 - $51.83 per hour
...experience Experience or exposure to discharge planning Experience in utilization review, concurrent review or risk management Background in managing populations with complex medical or behavioral needs Acute care experience *All Telecommuters will...Hourly payMinimum wageFull timeWork experience placementLocal areaRemote work- ...appropriate referrals. Provides ongoing review and development of educational materials... ...continuity of care and appropriate resource utilization and length of stay. Coordinates... ...nursing experience ~ MI Registered Nurse (RN) ~ AHA or ARC Basic Life Support (BLS)...Full timeMonday to FridayShift workWeekend work
$38 - $42 per hour
...RN Detroit, Michigan Salary: $38 - $42 / per hour Maxim... ...Responsibilities: Utilizes the nursing process to plan,... ...or supervisor Administers medications and treatments as prescribed,... ...effectiveness of intervention Reviews plan of care and program protocols...Hourly payWeekly payContract workTemporary work$38 - $42 per hour
...hiring for a Registered Nurse (RN) in Detroit, MI to work with... ...Responsibilities: Utilizes the nursing process to plan,... ...or supervisor Administers medications and treatments as prescribed,... ...effectiveness of intervention Reviews plan of care and program protocols...Hourly payWeekly payContract workTemporary work
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