Nurse Reviewer

Qualifications2 years of bedside nursing experienceActive PHRN license (will not accept someone with USRN)ResponsibilitiesReview and evaluate clinical information and documentation.Handle fax triage and provider calls.Interpret data from clinical records/systems, applying clinical criteria and policy in compliance with regulatory/accreditation...

Join our dedicated team at HBiz where we strive to provide outstanding care and service excellence. We are currently seeking a highly skilled Clinical Appeals Nurse to play a crucial role in managing medical denials by providing clinical expertise in the appeals process. This position is ideal for those who excel in analytical thinking and have a strong...

Join our CP360 Family, todayFrom Maple Leaf to Cebu: Proudly Cebuano, Uniquely CanadianJoin Our Canadian-Inspired Team in Cebu: Embrace Excellence TogetherWhy Join ContactPoint360? At ContactPoint360, we think differently. We believe in putting employees at the heart of everything we do, creating a culture where innovation and empathy are not just...

Responsibilities:Revise infection control procedures based on evidence and regulationsConduct audits and train staff on hygiene, PPE, and cleaningTrack infections and manage outbreaksDeliver training on infection control and emerging diseasesCollaborate with departments and agencies on infection controlAnalyze and report infection data to stakeholdersLead...

Select VoiceCom is currently looking for Registered Nurses to start ASAP Check out what our Nurses have to say about working with us: Select VoiceCom is an American and Australian-owned company providing call center services. While our main goal is to provide first-class service to all of our clients, this is directly linked to our goal of providing a great...

Job DescriptionResponsible for the review and evaluation of clinical information and documentation.Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.Independently coordinates the...

Position Summary:Receiving and processing patient admissions, responding to questions, assisting with the developmentof an initial plan of care, and providing exceptional customer service.Duties and Responsibilities:Assist with the processing of in-home patient care requests.Pre-fill medication profile of patients.Review and transfer medical charts and notes...

MVP Asia Pacific Inc We got you Join our growing team of MVPs Care Management Nurse (WFH, G.Y.)Job Description: Utilize clinical judgment, independent analysis, critical thinking, time management, and detailed knowledge of the Care Navigation Program to facilitate the coordination of care for patients. Collaborate with clinical and non-clinical staff and...

At Nezda, we are seeking a skilled and experienced Utilization Review Nurse to join our team.Key Responsibilities:Reviews service requests to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.Conducts medical management review activities which require the review of clinical information against...

ResponsibilitiesPrioritize incoming authorization and referral requests according to queue urgencyReview patient's clinical and chart documentation related to the service submitted by the provider's officeObtain and/or follow up on authorization and referral requests from the patient's payer through any of the following methods—depending on the payer's...