Monitoring and analyzing medical management activities. Qualifications for this position include: A current, valid and unrestricted RN licensure in your state of residence. 5+ years clinical experience in an acute care or an outpatient setting.
Coordinating medical care telephonically. Working with Insurance carriers, Employers, Providers, Injured Worker's and Attorneys. Qualifications for this position include: Excellent skills in Microsoft applications, and Outlook. Superior written and oral communication skills.
A health benefits company is in need of a Telecommute Medical Case Manager in the Nashville Area. Core Responsibilities of this position include: Conducting a thorough and objective evaluation of the client’s current status. Identifying opportunities for intervention.
Determine medical appropriateness of inpatient and outpatient services. Ensure proper utilization of health services by assessing the member's needs and identifying solutions. Required Skills: Demonstrated nursing knowledge and competency in all types of medical-necessity decisions.
Must be able to: Determine medical appropriateness of inpatient and outpatient services. Ensure proper utilization of health services. Identify solutions to problems and non-standard requests. Skills and Requirements Include: 2+ years of acute hospital clinical experience.
A healthcare company is in need of a Telecommute Medicare Appeals Specialist. Core Responsibilities Include: Completing and documenting thorough clinical investigation of all appeals. Reviewing outcome of appeal, either independently or in conjunction with medical director.
Medically managing cases by providing a full range of coordination and assessment services. Analyzing medical and return-to-work situations. Analyzing coverage, determining liability and extent of damages. Qualifications for this position include:
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.
Demonstrating understanding of use of all Medical Necessity software. Composing clinical appeal letters. Qualifications for this position include: Demonstrates proficiency in Microsoft Office applications and others as required.
A medical insurance company needs applicants for an opening for a Telecommute Senior Nurse Medical Manager. Core Responsibilities of this position include: Conducting pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews.