Talent.com
Tennessee Licensed Clinical Review Manager

Tennessee Licensed Clinical Review Manager

VirtualVocationsFresno, California, 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 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 • Fresno, California, United States

Job_description.internal_linking.related_jobs
  • serp_jobs.job_card.promoted
Licensed Clinical Manager

Licensed Clinical Manager

VirtualVocationsFresno, California, United States
serp_jobs.job_card.part_time
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_1_day
  • serp_jobs.job_card.promoted
Florida Licensed Clinical Review Nurse

Florida Licensed Clinical Review Nurse

VirtualVocationsVisalia, California, United States
serp_jobs.job_card.full_time
A company is looking for a Clinical Review Nurse - Concurrent Review.Key Responsibilities Performs concurrent reviews to determine members' overall health and appropriate level of care Reviews q...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
  • serp_jobs.job_card.promoted
  • serp_jobs.job_card.new
Texas Licensed Case Manager RN

Texas Licensed Case Manager RN

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
A company is looking for a Registered Nurse II - Case Manager.Key Responsibilities Manage continuity of care for beneficiaries through comprehensive assessments and care planning Coordinate foll...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
  • serp_jobs.job_card.promoted
Tennessee and Missouri RN Clinical Review Coordinator

Tennessee and Missouri RN Clinical Review Coordinator

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
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_1_day
  • serp_jobs.job_card.promoted
Texas Licensed Clinical Policy Manager

Texas Licensed Clinical Policy Manager

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
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_1_day
  • serp_jobs.job_card.promoted
  • serp_jobs.job_card.new
Remote Clinical Manager (RN)

Remote Clinical Manager (RN)

VirtualVocationsVisalia, California, United States
serp_jobs.filters.remote
serp_jobs.job_card.full_time
A company is looking for a Clinical Manager (RN - Remote - SCA).Key Responsibilities Supervise clinical staff and oversee day-to-day operations Monitor quality of care and compliance with polici...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
  • serp_jobs.job_card.promoted
  • serp_jobs.job_card.new
Texas Licensed Clinical Abstract RN

Texas Licensed Clinical Abstract RN

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
A company is looking for a Clinical Other - Abstract RN.Key Responsibilities Conduct electronic medical record abstraction services accurately and efficiently Abstract information from electroni...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
  • serp_jobs.job_card.promoted
  • serp_jobs.job_card.new
Clinical Resource Delivery Manager

Clinical Resource Delivery Manager

VirtualVocationsVisalia, California, United States
serp_jobs.job_card.full_time
A company is looking for a Clinical Resource Delivery Manager to lead clinical staffing processes in a remote setting.Key Responsibilities Design, implement, and improve clinical staffing workflo...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
  • serp_jobs.job_card.promoted
  • serp_jobs.job_card.new
Texas Licensed RN Case Manager

Texas Licensed RN Case Manager

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
A company is looking for a Case Manager RN.Key Responsibilities Assess member health status and coordinate care needs, including inpatient review and discharge planning Develop and implement tre...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
  • serp_jobs.job_card.promoted
South Carolina Licensed Clinical Assessor

South Carolina Licensed Clinical Assessor

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
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_1_day
  • serp_jobs.job_card.promoted
Texas Licensed Policy Manager

Texas Licensed Policy Manager

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
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_1_day
  • serp_jobs.job_card.promoted
  • serp_jobs.job_card.new
Texas Licensed Clinical Appeals Coordinator

Texas Licensed Clinical Appeals Coordinator

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
A company is looking for a Clinical Appeals Coordinator.Key Responsibilities Act as the liaison for statewide appeals, ensuring compliance with State and NCQA requirements Review clinical inform...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
  • serp_jobs.job_card.promoted
Tennessee Licensed Clinical Review Manager

Tennessee Licensed Clinical Review Manager

VirtualVocationsVisalia, California, United States
serp_jobs.job_card.full_time
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 ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
  • serp_jobs.job_card.promoted
  • serp_jobs.job_card.new
TX and GA Licensed Clinical Manager

TX and GA Licensed Clinical Manager

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
A company is looking for a Manager, Clinical Navigation.Key Responsibilities Lead and develop a team of Clinical Navigators to enhance patient engagement and outcomes Oversee daily operations of...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
  • serp_jobs.job_card.promoted
  • serp_jobs.job_card.new
Virginia Licensed Clinical Reviewer

Virginia Licensed Clinical Reviewer

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
A company is looking for a Lead Clinical Reviewer.Key Responsibilities Review medical records against criteria to determine medical appropriateness Guide team members and support training and do...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
  • serp_jobs.job_card.promoted
  • serp_jobs.job_card.new
Licensed Physical Therapy Reviewer

Licensed Physical Therapy Reviewer

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
A company is looking for a Clinical Reviewer, Physical Therapy.Key Responsibilities Evaluate cases that do not pass the authorization approval process and promote a supportive team approach Revi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
  • serp_jobs.job_card.promoted
  • serp_jobs.job_card.new
Licensed Clinical Case Manager

Licensed Clinical Case Manager

VirtualVocationsVisalia, California, United States
serp_jobs.job_card.full_time
A company is looking for a Clinical Case Manager Behavioral Health - Work at Home.Key Responsibilities Conduct comprehensive assessments of members' needs and eligibility for services Facilitate...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
  • serp_jobs.job_card.promoted
Georgia Licensed Clinical Policy Manager

Georgia Licensed Clinical Policy Manager

VirtualVocationsVisalia, California, United States
serp_jobs.job_card.full_time
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_1_day
  • serp_jobs.job_card.promoted
Minnesota Licensed Urology Reviewer

Minnesota Licensed Urology Reviewer

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
A company is looking for Board Certified Physician Reviewers specializing in Urology with a Minnesota license.Key Responsibilities Evaluate medical records and provide clinical summaries Engage ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
  • serp_jobs.job_card.promoted
NC Licensed Clinical Services VP

NC Licensed Clinical Services VP

VirtualVocationsFresno, California, United States
serp_jobs.job_card.full_time
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_1_day