Tennessee Licensed Clinical Review Manager

VirtualVocationsKissimmee, Florida, United States

job_description.job_card.30_days_ago

serp_jobs.job_preview.job_type

serp_jobs.job_card.full_time

job_description.job_card.job_description

A company is looking for a Clinical Review Manager to oversee medical reviews for utilization management.

Key Responsibilities

Initiate referrals for appropriate coordination of care

Assist in comprehensive provider and member appeals, including denial interpretation and retrospective claim reviews

Collaborate with the Medical Director and non-clinical staff as needed

Required Qualifications

Active Registered Nurse (RN) license in Tennessee or a participating state

Minimum of 3 years of clinical experience

Proficiency in Microsoft Office applications

Working knowledge of URAC, NCQA, and CMS accreditations

Ability to work independently and manage multiple projects

serp_jobs.job_alerts.create_a_job

Review Manager • Kissimmee, Florida, United States

Job_description.internal_linking.related_jobs

serp_jobs.job_card.promoted

Kentucky Licensed Care Manager

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Care Manager (RN) to develop and facilitate care management activities for members with physical needs. Key Responsibilities Evaluate member needs and recommend care pla...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30

serp_jobs.job_card.promoted

State Licensed Clinical Content Reviewer

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Clinical Content Editor - PGY-1 / Medical Students.Key Responsibilities Collaborate with a multidisciplinary team to create and curate content on emerging medical technol...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day

serp_jobs.job_card.promoted

Clinical Compliance Manager - RN

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Clinical Compliance Program Manager who will ensure compliance with Utilization Management and Quality Improvement Program regulations. Key Responsibilities : Facilitate ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days

serp_jobs.job_card.promoted

Ohio Licensed Patient Care Manager

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Patient Care Resource Manager - Retrospective Review.Key Responsibilities Conduct retrospective reviews of medical services to assess medical necessity and compliance w...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day

serp_jobs.job_card.promoted

LA Licensed Clinical Review Nurse

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Clinical Review Nurse - Concurrent Review.Key Responsibilities Perform concurrent reviews to determine overall health and appropriate level of care for members Review ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day

serp_jobs.job_card.promoted

Georgia Licensed Clinical Pharmacy Manager

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Manager of Clinical Pharmacy Programs to oversee and manage clinical pharmacy initiatives.Key Responsibilities Provide insights and recommendations for trend management...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days

serp_jobs.job_card.promoted

Florida Licensed UR Manager

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Regional Utilization Review (UR) Manager to oversee and support utilization review operations across multiple facilities. Key Responsibilities Manage and support facilit...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Wisconsin Licensed Clinical Review Nurse

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Clinical Review Nurse - Prior Authorization.Key Responsibilities Analyze prior authorization requests to determine medical necessity and appropriate level of care Coor...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted

Tennessee Licensed Senior Medical Reviewer

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Registered Nurse Senior Medical Reviewer (Home Health and Hospice).Key Responsibilities Acts as team leader for medical review and case management, providing guidance a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Texas Licensed Clinical Nurse Director

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Director of Utilization Management.Key Responsibilities Develop and implement strategic plans for Utilization Management aligned with organizational goals Direct all U...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted
serp_jobs.job_card.new

RN Licensed Senior Bill Reviewer

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Senior Complex Bill Reviewer.Key Responsibilities Conduct medical reviews of provider and hospital bills for accuracy and compliance Audit complex medical bills and va...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted

New York Licensed Clinical Review Nurse

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Clinical Review Nurse.Key Responsibilities Perform Utilization Review activities in accordance with jurisdictional guidelines Assess medical necessity and appropriaten...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30

serp_jobs.job_card.promoted

RN Clinical Documentation Consultant

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a CDI Consultant to support clinical documentation improvement in a remote capacity.Key Responsibilities Review and evaluate medical record documentation for completeness...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day

serp_jobs.job_card.promoted

Clinical Compliance Manager

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Manager, Business Standards and Oversight.Key Responsibilities Provide oversight for regulatory and contractually required document management related to Utilization Ma...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30

serp_jobs.job_card.promoted

South Carolina Licensed RN Reviewer

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for an RN Medical Reviewer II to perform medical reviews and support medical claims processing.Key Responsibilities Conduct medical claim reviews for complex services and det...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days

serp_jobs.job_card.promoted

Clinical Trial Manager

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Clinical Trial Manager (Remote & Full-Time).Key Responsibilities Manage project timelines, milestones, quality metrics, and budget targets for clinical trials Oversee ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Utilization Review Clinical Liaison

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Utilization Review Clinical Liaison.Key Responsibilities Serve as the primary point of contact for 1st level utilization review (UR) cases Coordinate 2nd level escalat...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted

Texas Licensed Utilization Review Specialist

VirtualVocationsKissimmee, Florida, United States

serp_jobs.job_card.full_time

A company is looking for a Utilization Review Specialist to monitor and ensure the effective use of outpatient services.Key Responsibilities Establish and maintain methods for ensuring medical ne...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days