Nurse - Clinical Case Management Specialist

Key ResponsibilitiesThe Clinical Case Manager will be responsible for:Performing initial and concurrent review of inpatient cases applying MCG criteria or InterQual Criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination.Discussing cases with facility healthcare professionals to obtain...

The Case Manager Nurse will regularly liaise with multiple clinical specialties and doctors. This role also involves consistent interactions with insurance providers, patients and their families, legal delegates, and representatives from other medical care institutions. Additionally, they will often communicate with nursing staff, billing teams, medical...

At BrightCare Assist Philippines Inc, we are seeking a highly skilled Clinical Case Manager to join our team. As a key member of our healthcare coordination unit, you will be responsible for managing patient cases and ensuring smooth claims processing.What You Will Do:Coordinate with healthcare providers and insurance companies to facilitate patient care and...

Nezda Technologies Inc. is currently hiring for Clinical Nurse Case Manager - USRN.Salary: P 50,000 - P 68,000 (with Perks and benefits).Work Set up: Work From HomeQualifications:Active and Non-Active USRN License.With at least 1 Year Clinical or Hospital Experience.USRN with RN License.Job Description:We are in partnership with multiple companies for this...

Nurse Case Managers at UnitedHealth Group are dedicated to helping people live healthier lives and making the health system work better for everyone. As a member of our team, you will have the opportunity to work collaboratively with healthcare professionals to develop and implement individualized care plans that meet the unique needs of each patient. We are...

About the Role:We are seeking a skilled Nurse Case Manager - Medical Necessity to join our team at Omega Healthcare Management Services Inc. The successful candidate will have experience in reviewing denied claims and determining the validity of denials.The ideal candidate will have a strong understanding of medical necessity and billing procedures, as well...

Job Summary:At Omega Healthcare Management Services Inc., we are seeking a highly skilled Clinical Appeals Specialist to join our team. As a key member of our appeals team, you will be responsible for reviewing denied insurance claims and determining the validity of denials.The successful candidate will have experience in clinical nursing or case management,...

ActiveOne Health, Inc. is committed to providing high-quality healthcare services to its employees.Job Description:The successful candidate will provide expert guidance on health screening results and recommend interventions.They will collaborate with the Company Doctor during check-ups and ensure accurate medical records.Responsibilities:Direct Care...

Beneath the umbrella of Allianz PNB Life Insurance, Inc. (formerly PNB Life Insurance Inc.), we are seeking a skilled Pre-Authorization Nurse to join our team.Key Responsibilities:We require a highly skilled nurse who will be responsible for the pre-authorization of in-patient treatments and ensuring cost containment through efficient adjudication and...

WE ARE AN OPHTHALMOLOGY SURGICAL CLINIC IN NEED OF A CLINIC NURSE WHO WILL ASSIST IN THE TREATMENT AND CARE OF OUR OUTPATIENT DEPARTMENT.THE CANDIDATE WILL BE TRAINED IN OPHTHALMOLOGIC NURSING AS WELL AS ASSISTING IN OPERATING ROOM PROCEDURES.How do your skills match this job?Your application will include the following questions:What's your expected monthly...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. Our team plays a vital role in improving health outcomes by connecting individuals with the care, pharmacy benefits, data and resources they need to thrive. As a Clinical Utilization Specialist, you will join a diverse and inclusive culture...

Job DescriptionThe Medical Oncology Case Manager position at Vee Technologies Philippines requires a skilled professional to coordinate patient care and manage clinical workflows. The successful candidate will liaise with multiple clinical specialties, doctors, insurance providers, patients, families, legal delegates, and representatives from other medical...

Overview:Omega Healthcare Management Services Inc. is seeking a highly skilled Appeals Nurse Specialist - Interqual Expert to join our team. The successful candidate will have experience in reviewing denied claims and determining the validity of denials.The ideal candidate will have a strong understanding of medical necessity and billing procedures, as well...

As a Clinical Support Specialist at BrightCare Assist Philippines Inc, you will play a vital role in ensuring seamless claims processing for our patients. Your primary responsibility will be to coordinate with healthcare providers and insurance companies to resolve any issues that may arise during the claims process.You will also act as a liaison between...

As a Clinical Coordinator, you will play a vital role in ensuring that patients receive top-notch care and support every step of the way. You will work closely with our US-based healthcare client to provide comprehensive case management services.The Key Requirements:A valid USRN - NY nursing licenseA graduate degree in BS Nursing or similar fieldMinimum 2...

Job Description:Our team seeks an experienced Nurse - Clinical Case Management Specialist to coordinate the administration of disembarked crew member medical cases.This includes approval and reimbursement requests, and notices regarding unfit, fit-to-travel, fit-to-fly, and fit-to-work status.You will address queries or concerns raised during the case...

At Limitlessli we specialize in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. Leveraging our extensive global network, we connect clients with highly qualified professionals, offering tailored services to meet our clients' unique business needs.The Opportunity:Are you a healthcare professional with...

Clinical Appeals Specialist (Registered Nurse)Our partner in the BPO industry is looking for Clinical Appeals Writers to help navigate the complexities of medical claim denials and ensure fair resolutions for patients and providers.100% Remote – Work from anywhereDay Shift Hours – Enjoy a consistent scheduleWhat You'll Do:Prepare and Submit Clinical...

We are looking for a dedicated Clinical Quality Improvement Nurse to join our team at the Dr. Jesus C. Delgado Memorial Hospital. As a Clinical Quality Improvement Nurse, you will play a critical role in improving the quality of care provided to patients.Responsibilities:Quality Improvement: Assist in identifying areas of improvement to reduce infection...

About ActiveOne Health, Inc.We are a leading provider of healthcare services dedicated to delivering high-quality patient care. Our team is passionate about making a positive impact on people's lives.Job DescriptionAs a Clinical Care Specialist, you will be responsible for providing expert clinical guidance and support to patients with occupational and...