A company is looking for a Clinical Review Nurse - Retrospective Review.Key ResponsibilitiesPerform clinical retrospective reviews of services to assess appropriateness and complianceReview medical records for necessity and quality of care, referring issues to the Medical Director as neededDocument and maintain member clinical information to ensure regulatory complianceRequired QualificationsGraduate from an Accredited School of Nursing or Bachelor's degree in Nursing2 - 4 years of related experienceClinical knowledge to analyze medical records for appropriate care servicesKnowledge of Medicare and Medicaid regulations preferredRN license required for Health Net of California
Licensed Clinical Review Nurse
A company is looking for a Clinical Review Nurse - Prior Authorization to analyze prior authorization requests for medical necessity and appropriate levels of care. ...
Registered Nurse Clinical Manager, RN
Ensures smooth and efficient processing of patients in the department; ensures established quality assurance, Joint Commission, UDS standards and infection control activities are performed according to policy* Attends mandatory supervisory nursing meetings and occasional weekend trainings as require...
Clinical Review Nurse - LPN
A company is looking for a Clinical Review Nurse - Concurrent Review to perform concurrent reviews and evaluate member care. ...
Registered Nurse Clinical Leader (RN) - Medicine
Under the direction and general supervision of the Nurse Manager, the clinical nurse leader utilizes evidence based practices in accordance with the State Nurse Practice Act, policies and procedures of the hospital and as directed by the medical staff. The clinical nurse leader is recognized as prof...
Utilization Review Nurse - RN
A company is looking for a Utilization Review Nurse to perform utilization review work for emergency admissions and continued stay reviews. ...
Clinical Nurse Educator (RN, BSN) - Perianesthesia
The Nursing Professional Development (NPD) Practitioner is a Register Nurse with NPD practice judgement and expertise who influence professional role competence and growth of learners. The NPD practitioner is responsible for supporting learners within the context and framework of the Nursing Profess...
Full Time RN Clinical Case Manager. Registered Nurse, Home Care
Job Title: Full Time RN Clinical Case Manager - Registered Nurse, Home Care. If you are a self-motivated Registered Nurse seeking to make a difference in people's lives as a Clinical Case Manager and are looking for a place to grow professionally, apply today to join the great team at Nurses at Home...
Clinical Team Manager (RN, Registered Nurse) - HomeCare
Maintains compliance with regulatory agency policies and procedures by providing staff guidance in making clinical and case management decisions that are cost effective and focused on clinical outcomes . Utilizes clinical software to identify opportunities for education, most appropriate u...
Registered Nurse Clinical Leader (RN) - Rehab
We are seeking dedicated and caring Registered Nurse Leader (RN) to be part of a team with a patient-centered approach, bringing decades of experience in providing the most innovative care. Our dedication to delivering personalized coordinated care coupled with the healing environment offered ...
Registered Nurse Clinical Leader (RN) - Neuro Surgical
Under the direction and general supervision of the Nurse Manager, the clinical nurse leader utilizes evidence based practices in accordance with the State Nurse Practice Act, policies and procedures of the hospital and as directed by the medical staff. The clinical nurse leader is recognized as prof...