serp_jobs.error_messages.no_longer_accepting

Tennessee Licensed Clinical Review Manager

VirtualVocationsErie, Pennsylvania, United States

job_description.job_card.variable_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 • Erie, Pennsylvania, United States

Job_description.internal_linking.related_jobs

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Oregon Licensed Clinical Peer Review RN

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

A company is looking for a Clinical Peer Review RN Coordinator (Performance Improvement).Key Responsibilities Coordinate and manage peer review processes with precision and discretion Serve as a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted

Licensed Physical Therapy Reviewer

VirtualVocationsErie, Pennsylvania, 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_1_day

serp_jobs.job_card.promoted

Texas Licensed Clinical Appeals Coordinator

VirtualVocationsErie, Pennsylvania, 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_1_day

serp_jobs.job_card.promoted

Florida Licensed Preservice Review Nurse

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

A company is looking for a Preservice Review Nurse RN - Remote.Key Responsibilities Perform clinical coverage review services, interpreting state and federal mandates and clinical information Co...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30

serp_jobs.job_card.promoted

Clinical Integration Lead

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

A company is looking for a Clinical Automation and Integration Lead - Remote.Key Responsibilities Serve as the clinical subject matter expert and lead for project teams defining clinical requirem...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days

serp_jobs.job_card.promoted

Texas Licensed Senior Care Manager

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

A company is looking for a Senior LTSS Service Care Manager (RN).Key Responsibilities Perform care management duties for complex / high acuity populations Develop personalized care plans and educa...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day

serp_jobs.job_card.promoted

Texas Licensed Case Manager RN

VirtualVocationsErie, Pennsylvania, 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_1_day

serp_jobs.job_card.promoted

Clinical Resource Delivery Manager

VirtualVocationsErie, Pennsylvania, 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_1_day

serp_jobs.job_card.promoted

New York Licensed Clinical Appeals Specialist

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

A company is looking for a Clinical Denials & Appeals Specialist (Remote).Key Responsibilities Review and respond to Corporate Compliance Audits and denial trends Prepare and defend level of car...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30

serp_jobs.job_card.promoted

Arizona Licensed Trauma Registrar

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

A company is looking for a Trauma Registrar to manage clinical data for trauma patients.Key Responsibilities Collect and abstract clinical data from various sources for trauma patients Code inju...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day

serp_jobs.job_card.promoted

Georgia Licensed Policy Manager

VirtualVocationsErie, Pennsylvania, 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 drive affordabil...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days

serp_jobs.job_card.promoted

Texas Licensed Policy Manager

VirtualVocationsErie, Pennsylvania, 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_variable_days

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Licensed Clinical Case Manager

VirtualVocationsErie, Pennsylvania, 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

Illinois Licensed Clinical Pharmacist Manager

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

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

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Texas Licensed Utilization Management RN

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

A company is looking for a Fertility Utilization Management RN - Remote.Key Responsibilities Determine the appropriateness of inpatient and outpatient services based on medical guidelines and ben...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted
serp_jobs.job_card.new

RN Clinical Navigator

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

A company is looking for a RN Clinical Navigator to support doctors and patients in a remote healthcare setting.Key Responsibilities Manage communications and documentation between patients and d...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Missouri Licensed Utilization Review Lead

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

A company is looking for a Utilization Review Coordinator, Lead.Key Responsibilities Serve as a liaison among physician, nursing staff, and ancillary departments to facilitate patient processing ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted
serp_jobs.job_card.new

NC Licensed VP of Clinical Operations

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

A company is looking for a VP of Clinical Operations to provide leadership and oversight for Clinical Services and Casualty departments. Key Responsibilities Oversee all Clinical Services function...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted
serp_jobs.job_card.new

Tennessee Licensed Senior Medical Reviewer

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

A company is looking for a Registered Nurse Senior Medical Reviewer (Medicare Part B).Key Responsibilities Lead and provide guidance to staff in specialty programs, medical review, and utilizatio...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours

serp_jobs.job_card.promoted

Clinical Services Project Manager

VirtualVocationsErie, Pennsylvania, United States

serp_jobs.job_card.full_time

A company is looking for a Clinical Services Project Manager for an entry-level contract position.Key Responsibilities Manages multiple clinical and lab services projects from initiation through ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30