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- A healthcare organization seeks a Clinical Reviewer to support medical claims and appeals review activities... ...claims. Candidates must have an active RN license and at least 2 years of nursing experience, including utilization review and coding. Strong analytical skills and...SuggestedHourly pay
$29.05 - $56.64 per hour
...experienced Registered Nurse to support medical claims and appeals review, ensuring compliance with regulations and guidelines.... ...clinical nursing experience, including experience in areas like utilization review and medical coding. The role involves performing clinical...SuggestedHourly pay- ...to the physician advisor, PA moonlighter, for a second level review as needed. Facilitates communication with service based multidisciplinary... ...3 years of acute care nursing experience is required; prior utilization management or case management experience is required. A...SuggestedTemporary workRemote workShift workWeekend work
- ...emphasizes high-quality patient-centered care through detailed Utilization Review. Responsibilities include managing healthcare service... ...compliance with regulations. Candidates should have an active RN license in Illinois and over 5 years of relevant experience. The...SuggestedRemote job
- ...leading healthcare company is seeking a Remote Physician Clinical Reviewer specialized in cardiology. The role involves providing medical... ...requires timely communication and an understanding of utilization management principles, supporting the efficiency of patient care...SuggestedRemote job
$29.05 - $67.97 per hour
...Job Description Job Summary As a Clinical Review Nurse, you will play a vital role in... ...and resolve escalated complaints regarding utilization management and long-term services and supports... ..., or related fields. Current, active RN license in good standing. Proficiency in...SuggestedHourly payWork at officeMolina Healthcare
La Crosse, WI3 days ago$68 - $73 per hour
...all Oncology administrative and clinical utilization management and quality improvement functions... ...: Conducts initial clinical review of incoming cases, rendering authorization... ...CERTIFICATION: Current, unrestricted state PA or RN/NP license in medicine or required...SuggestedWork at officeImmediate startEvolent
Madison, WI6 hours ago$76k - $85k
A leading public sector solutions firm is seeking a Utilization Review Nurse to work remotely. This role involves conducting prior authorizations, performing reviews, and using medical management software. The ideal candidate will have a nursing degree, at least 2 years...SuggestedRemote job$41 - $45.5 per hour
...License Required: Active, unrestricted RN License Must have MCG/InterQual experience... ...clinical assessments, health education, and utilization management. Key Responsibilities:... ...prospective, concurrent, and retrospective reviews for inpatient, rehab, referrals, and select...SuggestedRemote job- ...focusing on patient assessment and care coordination. Candidates must have a minimum of 3 years of acute care nursing experience, with utilization management knowledge preferred. The role includes working within a multidisciplinary team to enhance patient outcomes. The job...SuggestedRemote job
$76k - $85k
...public sector. To learn more, visit PCG is currently seeking a Utilization Review Nurse. The Utilization nurse will also be responsible for... ...care environment, Medicaid or hospital utilization management RN required Working Conditions Remote The above is intended to...SuggestedFor contractorsH1bWork at officeLocal areaRemote work$29.05 - $67.97 per hour
...support for medical claim and internal appeals review activities - ensuring alignment with... ...Resolves escalated complaints regarding utilization management and long-term services and supports... ...and experience. Registered Nurse (RN). License must be active and unrestricted...SuggestedHourly payWork experience placementWork at officeMolina Healthcare
La Crosse, WI4 days ago- ...completion of the Annual Standing Order Review and Internal Classification of Disease (ICD... ...clinic financials including efficient utilization of supplies or equipment and regular profits... ...of an accredited School of Nursing (RN). Current appropriate state licensure. EXPERIENCE...SuggestedFull time
- Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently... ...and Workers’ Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-clinical role offering...SuggestedPrice workExtra incomeFor contractorsRemote workFlexible hours
- 1 month ago Be among the first 25 applicants Description Dane Street, a leading Independent Review Organization (IRO) and national provider of Utilization Review (UR) services, is currently expanding our physician panel. We are seeking Board-Certified Orthopedic Surgeons...SuggestedExtra incomeContract workFor contractorsRemote workFlexible hours
- A healthcare company is seeking a Remote Utilization Management Behavioral Health RN Intern for a supportive internship program aimed at military service... .... Responsibilities include conducting clinical reviews and collaborating with healthcare providers. This role...Remote jobInternshipWork from home
- ...transitioning military and military spouses. The Utilization Management Behavioral Health Registered Nurse Intern will conduct clinical reviews, communicate with healthcare providers, and... ...findings. Applicants must have an active RN license and at least two years of clinical...Remote jobInternship
$29.05 - $56.64 per hour
...support for medical claim and internal appeals review activities - ensuring alignment with... ...Resolves escalated complaints regarding utilization management and long-term services and supports... ...and experience. Registered Nurse (RN). License must be active and unrestricted...Remote jobHourly payWork experience placementWork at office$99.7k - $166.1k
...completion of the Annual Standing Order Review and Internal Classification of Disease (ICD... ...clinic financials including efficient utilization of supplies or equipment and regular profits... ...of an accredited School of Nursing (RN). Current appropriate state licensure. EXPERIENCE...Full timeWork experience placementFresenius Medical Care
Calumet County, WI1 day ago- A national health organization is seeking a Clinical Review Clinician - Appeals to conduct clinical reviews and manage appeals. The role requires an accredited nursing degree and relevant experience, preferably in NCQA standards and healthcare regulations. The position...Remote jobFlexible hours
- ...Manager/Clinical Coordinator. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And... ...For Customer Service, Teamwork, Resource Utilization, And Staff And Self Development As Outlined In Performance Review. # Performs Other Duties As Assigned Or Directed...
$90.87 - $154.33 per hour
...driven career? Come build the future of pharmacy with us. Job Posting Title Physician Clinical Reviewer - Dermatology- REMOTE Job Description Key member of the utilization management team, and provides timely medical review of service requests that do not initially...Remote jobWork at officeLocal areaVisa sponsorshipWork visa$90.87 - $154.33 per hour
...a purpose-driven career? Come build the future of pharmacy with us. Job Title Physician Clinical Reviewer - Psychiatry- REMOTE Job Description Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet...Remote jobWork at officeLocal areaVisa sponsorshipWork visa$2,306 per week
...Staffing-Nursing is seeking a travel nurse RN PreOp / PACU - Post Anesthesia Care for a... ...patients pre-operatively, including reviewing medical history, performing physical examinations... ...Respond promptly to emergency situations utilizing Pre/post op nursing standards, policies,...Weekly payTemporary workShift workFusion Medical Staffing-Nursing
Menomonee Falls, WI3 days ago- ..., compliant, patient‑centered care through precise and timely Utilization Review. In this role, you will apply clinical expertise and regulatory... ...Qualifications ~ Active, unrestricted Registered Nurse (RN) license in Illinois. ~5+ years of experience across varied...Bi-weekly payFull timeTemporary workFor contractorsLocal areaRemote workWork from home
- Join our Medical Bill Review team to ensure accurate processing of wage loss and medical claims using applicable laws; manage routine... ...IME, surveillance, non-emergency transportation, interpreter, utilization review, non-medical consulting, nurse case manager, etc....Work experience placementWork at officeImmediate startHome officeMonday to Friday
Sentry Insurance
Stevens Point, WI6 hours ago $38 - $45 per hour
...Program Responsibilities: Utilizes the nursing process to plan, implement, and... ...effectiveness of intervention Reviews plan of care and program protocols and identifies... ...: Current Registered Nurse (RN) License for the state in which the nurse...Weekly payContract workTemporary workMaxim Healthcare Service
Marshfield, WI4 days ago- A leading Pharmacy Benefit Manager is seeking a Physician Clinical Reviewer for Psychiatry. In this remote role, you will be a vital member of the utilization management team, providing timely medical reviews of service requests. The ideal candidate will have a DO, MBBS...Remote job
$1,077 per week
...TalentBurst, Inc is seeking a travel nurse RN ICU - Intensive Care Unit for a travel... ...Actively coordinates the discharge plan utilizing an interdisciplinary approach. Applies evidence... ...: 3 years First-time traveler: Upon review Patient Types: Multi specialty ICU - High...Full timeContract workTemporary workShift workTalentBurst
Green Bay, WI3 days ago$2,098 per week
...TNAA TotalMed RN is seeking a travel nurse RN ED - Emergency Department for a travel... ...nnnnESSENTIAL DUTIES AND RESPONSIBILITIESnn Utilizes the nursing process and collaborates with... ...activities and decisions and peer review process. About TNAA TotalMed RN TotalMed...Weekly payPermanent employmentReliefLocal areaShift workNight shiftTNAA TotalMed RN
Orfordville, WI1 day ago
