Medical Review Nurse jobs

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Utilization Review Nurse
Mercy - 200 reviews - Springfield, MO
The Utilization Review Nurse is responsible for the development, implementation, coordination, and follow-up of projects related to Mercy Care Management....
Weekend-RN Telemedicine Ambulatory
Mercy - 200 reviews - Chesterfield, MO
Work requires analytical skills and knowledge of complex medical patients, anatomy, EKG reading (etc.)....
Nurse Manager I-ED
Texas Health Resources - 259 reviews - Fort Worth, TX 76104
Responsible for personnel functions including staff, performance reviews and corrective action. Texas Health Fort Worth has an exciting opportunity for a Nurse...

Quality Improvement Nurse (RN) - Work At Home (KY, IN or OH...

Humana - 2,355 reviews - Louisville, KY  +1 location
Extensive Review of medical records and identify needed improvements that impact HEDIS measures or coding (i.e....

Medicare Medical Review Nurse

NCI Information Systems, Inc. - 2 reviews - Miami, FL  +2 locations
As the Medicare Medical Review Nurse ( Medical Reviewer ), you will primarily responsible for conducting clinical reviews of medical records during the course...

Medical Review Nurse Auditor - Home-based - Wyoming

Quality Health Strategies - 9 reviews - Wyoming  +5 locations
Health Integrity has exciting opportunities for Medical Review Nurse Auditors to join our Cerritos, CA based United Program Integrity Contractors (UPIC) team....
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RN Appeals Analyst

BlueCross BlueShield of South Carolina - 3,758 reviews - Columbia, SC
Provides thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines....

Medical Claim Review Nurse

Molina Healthcare - 350 reviews - Spokane, WA
1-3 years clinical nursing experience, including 1 year Utilization Review and/or Medical Claims Review experience. Assists with Complex Claim review;...

RN - Utilization Reviewer

Avera Health - 14 reviews - Mitchell, SD
Reviews patient's medical records for identification of and need of on-going hospitalization, accurate level of care, requirements for medical necessity and...

Medical Review Nurse

NCI Information Systems, Inc. - 2 reviews - Baton Rouge, LA  +2 locations
As the Medicare Medical Review Nurse ( Medical Reviewer ), you will primarily responsible for conducting clinical reviews of medical records during the course...

UPIC Medical Review Nurse

Noridian Healthcare Solutions, LLC - 5 reviews - Little Rock, AR  +6 locations
Maintaining Medical Review (MR) Activities:. Review of Claims for Medical Necessity:. The UPIC Medical Review Nurse conducts medical record and claims review...

Medical Review Nurse

SCAN Health Plan - 47 reviews - Long Beach, CA 90806
Medical Review Nurse. As a Medical Review Nurse you will. Provide clinical review of medical claims and post service appeals....

Appeals Reviewer RN - Case Management Resource Center

Adventist Health Southern California Network - Glendale, CA
The preparation of this information will be based on accepted industry criteria.Job DutiesPerforms retrospective, post discharge, and post serviced medical...
RN Clinical Appeals Analyst
Piedmont Healthcare - 187 reviews - Atlanta, GA 30363
Perform retrospective (post -discharge/ post-service) medical necessity reviews to determine appropriateness of level of care documented and provided using...
Clinical Appeals RN
WellCare - 615 reviews - Tampa, FL 33634
2 years of experience in a clinical setting with general nursing exposure in utilization management (UM), to include pre-authorization, utilization review,...

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