A company is looking for a Clinical Review Clinician - Appeals (RN).Key ResponsibilitiesPerform clinical reviews to resolve and process appeals based on medical necessityPrepare case reviews for Medical Directors and ensure timely processing of appealsCommunicate with members, providers, and facilities regarding appeal requestsRequired Qualifications, Training, and EducationGraduate from an Accredited School of Nursing or Bachelor's degree in Nursing2 - 4 years of related experience, including appeals and utilization managementKnowledge of NCQA, Medicare, and Medicaid regulations preferredOne of the following licenses is required : RN, LPN, LVN, LCSW, LMHC, LPC, LMFT, or Licensed Psychologist
Clinical Review Nurse - NM Licensed
A company is looking for a Clinical Review Nurse - Concurrent Review to perform concurrent reviews and evaluate the quality of care for members. ...
HEDIS/ Clinical Medical Review Nurse
The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication. The incumbent will handle pre and post claim ...
Clinical Review Nurse - NY Licensed
A company is looking for a Clinical Review Nurse - Concurrent Review to perform concurrent reviews and evaluate member care. ...
Clinical Medical Review Nurse
The Clinical Medical Review Nurse (RN/LPN) will report to the Clinical Support Supervisor HEDIS and work as part of the Quality Team. Position: Clinical Medical Review Nurse. Communication, interpersonal skills, clinical knowledge, and organization. ...
Clinical Review Nurse
A company is looking for a Clinical Review Nurse responsible for reviewing health claims and making medical determinations. ...
Clinical Medical Review Nurse
Current knowledge of clinical practices related to HEDIS and Medical Record Review - Advanced. Prior experience in HEDIS and overread review is essential for this role. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors. Medical Recor...
Clinical Medical Review Nurse
Calibri, sans-serif; font-size: 11pt;">Position: Clinical Medical Review Nurse</b><br /> <b>Location: Baltimore, MD #HYBRID (occasionally be required to visit provider offices)</b><br /> <b>Duration: Long term</b></div> <div> <p><...
HEDIS Clinical Review Nurse
The Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication. Seeking a Medical Review Nurse for a 6 month contract ...
Clinical Medical Review Nurse
ALTA IT Services is staffing a contract opportunity for a Clinical HEDIS Specialist support a leading health insurance customer. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors. Medical Record Retrieval, Abstraction and Research du...
Health Services - Nurse, Clinical Medical Review Nurse, Clinical Medical Review
The Clinical Medical Review Nurse (an RN with clinical experience) will report to the Clinical Support Supervisor – HEDIS and be part of the Quality Team. Current knowledge of clinical practices related to HEDIS and Medical Record Review - Advanced. Correct errors identified through over-read proces...