A staffing agency is searching for a person to fill their position for a Remote Nurse Medical Reviewer. Individual must be able to fulfill the following responsibilities: Evaluating, identifying, and reporting on, quality of care issues. Receiving requests for pre-certification of procedures.
A healthcare company is in need of a Telecommute Medical Review Registered Nurse . Core Responsibilities Include: Conducting on-site reviews of subscriber medical information. Ensuring appropriate benefit administration. Compiling weekly, monthly and quarterly reports.
An insurance company has an open position for a Telecommute Workers Compensation Medical Case Manager. Individual must be able to fulfill the following responsibilities: Attend medical appointments with an injured worker. Manage one-time task assignment or full field case management referral.
Accurately reviewing medical records/charts collected from provider offices. Applicants must meet the following qualifications: Ability to travel as needed. Valid, unrestricted state nursing license (L. P. N. or R. N. ) Recent experience in HEDIS data abstraction.
3-5 years Medical Surgery, Heart, Lung or Critical Care Nursing experience. Prior clinical experience. Comprehensive knowledge of Microsoft Word, Outlook and Excel. Home office with locking door and DSL/cable modem (10mbs download/1mbs upload minimum)
A healthcare company is in need of a Telecommute Medicare Quality Consultant Registered Nurse in Pensacola. Core Responsibilities Include: Assisting members to obtain preventive screenings and review for adherence with prescribed medications.
A healthcare company has a current position open for a Telecommute Multiple Level Nurse Medical Management in the Woodland Hills Area. Must be able to: Collaborate with healthcare providers and members to promote quality member outcomes.
Reviewing clinical appeals from participating inpatient and outpatient Medicare Advantage providers. Making medical necessity recommendations based on industry standards. Reviewing post service provider appeal requests. Qualifications for this position include: 0-10% Travel.
Gathering clinical information and applying the appropriate medical necessity criteria/guideline. Consulting and lending expertise to other internal and external constituents. Coordinating/Communicating with providers and other parties to facilitate optimal care/treatment.
Conducting medical management activities. Performing condition management and care coordination services. Required Skills: Initial training for this position will be approximately 3-4 weeks in the Dallas/Fort-Worth Area. Ability to travel occasionally as needed including overnight stays.