Tennessee Licensed Clinical Review Manager
VirtualVocationsMiami, Florida, United Statesjob_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 clinical information and ensure appropriate care for members.
Key Responsibilities
Research clinical information from providers using CMS guidelines to ensure members receive necessary services
Initiate referrals and coordinate care while consulting with the Medical Director as needed
Assist with administrative reviews and perform comprehensive appeals and claim reviews
Required Qualifications
Active Registered Nurse (RN) license in Tennessee or a participating Nurse Licensure Compact state
Minimum of 3 years of clinical experience
Proficiency in Microsoft Office (Outlook, Word, Excel, PowerPoint)
Knowledge of URAC, NCQA, and CMS accreditations
Ability to work independently in a fast-paced environment
serp_jobs.job_alerts.create_a_job
Licensed Clinical Manager • Miami, Florida, United States
Job_description.internal_linking.related_jobs A company is looking for a Clinical Appeals RN to work on post-service appeals for Medicare-based claims remotely.Key Responsibilities : Review provider post-service appeals for Medicare and Retir...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Manager, Vendor Clinical Policy to join their Clinical Policy team.Key Responsibilities Clinically evaluate vendor policy sets for compliance with medical standards and...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Clinical Documentation Specialist RN.Key Responsibilities Conducts concurrent reviews of clinical documentation in medical records to ensure compliance and accuracy for...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days Manager Pharmacist Clinical Capabilities, Remote.Key Responsibilities Anticipates customer needs and develops proactive solutions Serves as a key resource on complex issues and provides recommen...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Utilization Management RN PRN.Key Responsibilities Analyze patient records to assess hospital admissions, treatment legitimacy, and appropriate care levels Facilitate ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Manager, Policy Optimization to join their Clinical Policy team.Key Responsibilities Track policy performance and identify areas for process changes to enhance affordab...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a LOS Clinical Review Coordinator for TN and MO.Key Responsibilities Request and review member's clinical information from providers Perform utilization review of inpati...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Manager, Vendor Clinical Policy to join their Clinical Policy team.Key Responsibilities Evaluate vendor policy sets to ensure compliance with internal and external medi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Licensed Clinical Therapist (LCSW / LMHC / LMFT) for an Adult Intensive Outpatient Virtual Group.
Key Responsibilities Provide virtual IOP remote group coverage via video co...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Clinical Manager - Part-Time.Key Responsibilities Report directly to the Director of Therapy and manage a cohort of providers Maintain a clinical caseload and engage i...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Clinical Assessor, Mid - RN - Full-time (Remote U.Key Responsibilities Conduct assessments for Medicaid Waiver eligibility using state-approved tools Ensure privacy an...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for Board Certified Physician Reviewers specializing in Urology with a New Mexico License.Key Responsibilities Evaluate medical records and provide clinical summaries Engage...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Nurse Case Manager II.Key Responsibilities Utilizes a collaborative process for assessment, planning, facilitation, and advocacy to meet individual health needs Conduc...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day A company is looking for an RN Central Utilization Management.Key Responsibilities Conduct medical necessity reviews and clinical assessments for patient admissions and ongoing care Ensure timel...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Clinical Review Nurse - Concurrent Review.Key Responsibilities Perform concurrent reviews to assess member health and appropriate level of care Review quality and cont...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a VP, Clinical Services to provide leadership and oversight for Clinical Services and Casualty departments.
Key Responsibilities Oversee all Clinical Services functions an...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Clinical Response Manager.Key Responsibilities Develop and oversee strategies for patient admissions in alignment with the organization's mission Lead and mentor the R...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day A company is looking for a Registered Nurse (RN), Auditor.Key Responsibilities Review bills for accuracy compared to medical records Identify and correct ongoing problems through documentation r...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
- serp_jobs.job_card.promoted
Maryland Licensed Clinical Appeals RN
VirtualVocationsHollywood, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Georgia Licensed Clinical Policy Manager
VirtualVocationsFort Lauderdale, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Colorado Licensed Clinical Documentation Specialist RN
VirtualVocationsFort Lauderdale, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Illinois Licensed Clinical Pharmacist Manager
VirtualVocationsHollywood, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Florida Licensed Utilization Management RN
VirtualVocationsHollywood, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Texas Licensed Policy Manager
VirtualVocationsHialeah, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Tennessee and Missouri RN Clinical Review Coordinator
VirtualVocationsMiami, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Texas Licensed Clinical Policy Manager
VirtualVocationsHialeah, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Florida Licensed Clinical Therapist
VirtualVocationsFort Lauderdale, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Licensed Clinical Manager
VirtualVocationsDavie, Florida, United Statesserp_jobs.job_card.part_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
South Carolina Licensed Clinical Assessor
VirtualVocationsHialeah, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
New Mexico Licensed Urology Reviewer
VirtualVocationsFort Lauderdale, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Missouri Licensed Nurse Case Manager
VirtualVocationsHollywood, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Georgia Licensed Utilization Management RN
VirtualVocationsHialeah, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Texas Licensed Clinical Review Nurse
VirtualVocationsHialeah, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
NC Licensed Clinical Services VP
VirtualVocationsFort Lauderdale, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Clinical Response Manager
VirtualVocationsDavie, Florida, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Tennessee Licensed RN Auditor
VirtualVocationsDavie, Florida, United Statesserp_jobs.job_card.full_time