Core Responsibilities of this position include: Visiting MLTC and Managed Medicaid members in need of long term care. Conducting face-to-face UAS assessments. Supporting members with medication reviews and connections to services. Applicants must meet the following qualifications:
Performing clinical and medical reviews, data collection and database entry. Assisting in the transcription of physician reviews by editing and formatting. Qualifications Include: May be required to travel at least 10% of time based on business needs. Unrestricted RN license required.
Provide medical and wellness education. Diagnose and treat patients via our online platform. Position Requirements Include: Certified by the Board of Nursing and has an active California license to practice. Minimum of 5 years primary care and comfortable with differential diagnosis.
Safety and Pharmacovigilance experience. Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint), e-mail, and internet. Some understanding and usage of medical terminology. Strong organizational, presentation, documentation, analytical, oral/ written (English), and interpersonal skills.
A healthcare company has a current position open for a Telecommute Electronic Medical Records Specialist Registered Nurse. Candidates will be responsible for the following: Developing and providing quality improvement and training activities.
Reviewing requests for prior authorization of medical services. Reviewing provider requests to ensure medical necessity for services requiring preauthorization. Utilizing nationally recognized criteria to determine medical necessity of services requested.
Ensuring member access to medical necessary, quality healthcare in a cost effective setting. Collaborating with provider to identify proactive discharge planning for members. Position Requirements Include: Virginia residency required.
Individual must be able to fulfill the following responsibilities: Review medical records and to identify medical issues. Enhance the current services offered to their clients. Be available to claims adjusters for advice and referral. Position Requirements Include: Must have an RN License.
Ensuring delivery of medically necessary, appropriate, timely, cost-effective and quality health care services. Reviewing retrospective, prospective, and concurrent reviews. Required Skills: Three years of utilization management or discharge planning.
Completing initial medical records reviews of patient records within 24-48 hours of admission. Required Skills: Travel may be required to meet the needs of the facilities. Active state Registered Nurse license. Graduate from a Nursing program, BSN, or graduate.