Peer Review Nurse
Madera, CA ยท On-site
Will facilitate the peer review process and attend peer review meetings. Part Time Position with ... and utilization review. Requires proficiency in data abstraction, EHR systems, and critical ...
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Madera, CA ยท On-site
Will facilitate the peer review process and attend peer review meetings. Part Time Position with ... and utilization review. Requires proficiency in data abstraction, EHR systems, and critical ...
Quick apply
Madera, CA ยท On-site
Will facilitate the peer review process and attend peer review meetings. Part Time Position with ... and utilization review. Requires proficiency in data abstraction, EHR systems, and critical ...
At least one-year experience in the area of case management/utilization review, preferred Education:UNAVAILABLEEmployment Type: PART_TIME
At least one-year experience in the area of case management/utilization review, preferred Education:UNAVAILABLEEmployment Type: PART_TIME
Monterey Park, CA ยท Remote
$250K - $325K/yr
About the Role The PartTime Medical Director - Utilization Management, Outpatient Services provides ... Conduct peertopeer reviews and outpatient physician education to improve documentation, guideline ...
Monterey Park, CA ยท Remote
$250K - $325K/yr
About the Role The PartTime Medical Director - Utilization Management, Outpatient Services provides ... Conduct peertopeer reviews and outpatient physician education to improve documentation, guideline ...
This part-time role is internal-facing and requires strong clinical judgment, attention to detail ... Review clinical documentation and notes using applicable Cigna and CGHB clinical documentation and ...
This part-time role is internal-facing and requires strong clinical judgment, attention to detail ... Review clinical documentation and notes using applicable Cigna and CGHB clinical documentation and ...
Austintown, OH ยท On-site
... part-time work. ESSENTIAL FUNCTIONS: * Coordinate and manage behavioral health payer audits, denials, and utilization review activities * Prepare and submit audit responses, appeals, and supporting ...
Austintown, OH ยท On-site
... part-time work. ESSENTIAL FUNCTIONS: * Coordinate and manage behavioral health payer audits, denials, and utilization review activities * Prepare and submit audit responses, appeals, and supporting ...
Conduct peerโtoโpeer reviews and outpatient physician education to improve documentation, guideline adherence, and appropriate utilization. * Partner with Outpatient Medical Directors, Population ...
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Conduct peerโtoโpeer reviews and outpatient physician education to improve documentation, guideline adherence, and appropriate utilization. * Partner with Outpatient Medical Directors, Population ...
CLINICAL RESOURCE MANAGER BAKER CITY, Part-time GENERAL SUMMARY AND PURPOSE ... Provides hospital case management/utilization review and discharge planning collaboratively ...
CLINICAL RESOURCE MANAGER BAKER CITY, Part-time GENERAL SUMMARY AND PURPOSE ... Provides hospital case management/utilization review and discharge planning collaboratively ...
RN/Case Manager MSH Case Management PT Days The Case Manager (CM) will be responsible for all ... Reviews all new admissions to identify patients where utilization review, discharge planning, and ...
RN/Case Manager MSH Case Management PT Days The Case Manager (CM) will be responsible for all ... Reviews all new admissions to identify patients where utilization review, discharge planning, and ...
Oroville, CA ยท On-site
$18.63 - $24.35/hr
This part-time position requires 40-47 hours worked in a two-week pay period. Qualifications ... Performs a variety of routine daily tasks; reviews reports, prepares correspondence; and ...
Oroville, CA ยท On-site
$18.63 - $24.35/hr
This part-time position requires 40-47 hours worked in a two-week pay period. Qualifications ... Performs a variety of routine daily tasks; reviews reports, prepares correspondence; and ...
CLINICAL RESOURCE MANAGER BAKER CITY, Part-time GENERAL SUMMARY AND PURPOSE ... Provides hospital case management/utilization review and discharge planning collaboratively ...
CLINICAL RESOURCE MANAGER BAKER CITY, Part-time GENERAL SUMMARY AND PURPOSE ... Provides hospital case management/utilization review and discharge planning collaboratively ...
CLINICAL RESOURCE MANAGER BAKER CITY, Part-time GENERAL SUMMARY AND PURPOSE ... Provides hospital case management/utilization review and discharge planning collaboratively ...
CLINICAL RESOURCE MANAGER BAKER CITY, Part-time GENERAL SUMMARY AND PURPOSE ... Provides hospital case management/utilization review and discharge planning collaboratively ...
Grosse Pointe, MI ยท On-site
Part time- 20 hours a week Scope of Work: Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and ...
Grosse Pointe, MI ยท On-site
Part time- 20 hours a week Scope of Work: Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and ...
Grosse Pointe, MI ยท On-site
Part time- 20 hours a week Scope of Work: Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and ...
Grosse Pointe, MI ยท On-site
Part time- 20 hours a week Scope of Work: Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and ...
Los Angeles, CA ยท On-site
$30 - $34/hr
Position Summary Westwind Recovery is seeking a Part-Time Primary Therapist to provide clinical ... Support utilization review and other clinical needs as assigned.
Los Angeles, CA ยท On-site
$30 - $34/hr
Position Summary Westwind Recovery is seeking a Part-Time Primary Therapist to provide clinical ... Support utilization review and other clinical needs as assigned.
Los Angeles, CA ยท On-site
$30 - $34/hr
Position Summary Westwind Recovery is seeking a Part-Time Primary Therapist to provide clinical ... Support utilization review and other clinical needs as assigned.
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Los Angeles, CA ยท On-site
$30 - $34/hr
Position Summary Westwind Recovery is seeking a Part-Time Primary Therapist to provide clinical ... Support utilization review and other clinical needs as assigned.
Columbus, OH ยท On-site
$215K - $344K/yr
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Need 3-5 or more years in practice experience, prefer 2-4 years in FT/PT medical director or ...
Columbus, OH ยท On-site
$215K - $344K/yr
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Need 3-5 or more years in practice experience, prefer 2-4 years in FT/PT medical director or ...
Folsom, CA ยท Remote
$70K - $85K/yr
P.T. and I.C.D.9 codes preferred * Medical bill auditing experience preferred * Experience in the ... Prospective, concurrent and retrospective utilization review experience preferred PAY RANGE: CorVel ...
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Folsom, CA ยท Remote
$70K - $85K/yr
P.T. and I.C.D.9 codes preferred * Medical bill auditing experience preferred * Experience in the ... Prospective, concurrent and retrospective utilization review experience preferred PAY RANGE: CorVel ...
Melbourne, FL ยท On-site
Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise ...
Melbourne, FL ยท On-site
Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise ...
Medford, OR ยท On-site
$23.28 - $32.02/hr
... utilization review, and denials management activities as defined by the RN Discharge Coordinator ... Medical, dental, and vision coverage for part-time and above employees and their eligible ...
Medford, OR ยท On-site
$23.28 - $32.02/hr
... utilization review, and denials management activities as defined by the RN Discharge Coordinator ... Medical, dental, and vision coverage for part-time and above employees and their eligible ...
South Bend, IN ยท On-site
$17 - $21.50/hr
Medical, Dental, & Vision Insurance through Cigna * Life Insurance * 403(b) Matching Retirement ... Processes patient account updates, authorizations, utilization review requests, patient type ...
South Bend, IN ยท On-site
$17 - $21.50/hr
Medical, Dental, & Vision Insurance through Cigna * Life Insurance * 403(b) Matching Retirement ... Processes patient account updates, authorizations, utilization review requests, patient type ...
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
| Aspect | Part Time Cigna Utilization Review | Part Time Cigna Claims Processor |
|---|---|---|
| Certifications | Typically requires healthcare or insurance-related certifications | Usually requires basic insurance processing knowledge, no specialized certifications needed |
| Work Environment | Office-based, healthcare or insurance company setting | Office-based, insurance claims department |
| Job Responsibilities | Review medical necessity, approve or deny coverage based on policies | Process and review insurance claims for accuracy and completeness |
| Industry Usage | Common in health insurance companies like Cigna | Common in insurance companies, including Cigna |
Part Time Cigna Utilization Review focuses on evaluating medical necessity and approving coverage, requiring healthcare knowledge and certifications. In contrast, Part Time Cigna Claims Processor handles claims processing, emphasizing accuracy and data entry. Both roles are office-based within the insurance industry but serve different functions in claims management.
Part-time
Posted 29 days ago
Be an early applicant
Madera Community Hospital
Located in the heart of Central California, Madera Community Hospital is a General Acute Care, private, not-for-profit hospital dedicated to improving and maintaining the health and wellness of residents throughout the Central Valley. We are committed to identifying and serving our community's needs with compassion, concern, care and safety for every patient. Madera Community Hospital is a growing acute care facility seeking talented individuals with a drive to provide quality care and dedicated to making a difference in our community.
Position Summary:
The Peer Review Nurse will evaluate clinical documentation, patient charts, and care processes to ensure they meet quality standards, regulatory requirements, and medical necessity. Will identify opportunities to improve care, reduce risk, and prepare data for medical staff review committees. Will conduct comprehensive reviews of Electronic Medical Records (EMR) to assess the appropriateness and timeliness of care provided. Identifies trends, risks, and variations in clinical performance, preparing summary reports for committees. Will facilitate the peer review process and attend peer review meetings.
Part Time Position with flexible schedule.
Qualifications:
Requires completion of Registered Nurse program, prefer BSN. Requires Minimum 5 years clinical nursing experience, including experience in quality improvement and utilization review. Requires proficiency in data abstraction, EHR systems, and critical thinking.
Requires Current State of California Board of Registered Nursing License, Current American Heart Association BCLS certificate.
Madera Community Hospital provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Sourced by ZipRecruiter
501 - 1,000 Employees
Madera, CA, US
1971