We deliver strategic workforce solutions that help you manage your talent and business more ... Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for ...
We deliver strategic workforce solutions that help you manage your talent and business more ... Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for ...
Practice Coordinator/Treatment Planning-Scheduling/Front Desk
San Francisco, CA · On-site
$21 - $26.50/hr
Pend smart sets * Schedule surgeries * Work applicable work queues * Enter/edit outside test ... Messaging (CRM) if applicable * 2nd calls in CRM if applicable * Telephone encounters * My open ...
Practice Coordinator/Treatment Planning-Scheduling/Front Desk
San Francisco, CA · On-site
$21 - $26.50/hr
Pend smart sets * Schedule surgeries * Work applicable work queues * Enter/edit outside test ... Messaging (CRM) if applicable * 2nd calls in CRM if applicable * Telephone encounters * My open ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
PRACTICE CRD 3
$28.25 - $32.50/hr
Pend smart sets * Schedule surgeries * Work applicable work queues * Enter/edit outside test ... Messaging (CRM) if applicable * 2nd calls in CRM if applicable * Telephone encounters * My open ...
PRACTICE CRD 3
$28.25 - $32.50/hr
Pend smart sets * Schedule surgeries * Work applicable work queues * Enter/edit outside test ... Messaging (CRM) if applicable * 2nd calls in CRM if applicable * Telephone encounters * My open ...
PRACTICE CRD 2
Berkeley, CA · On-site
$29.50 - $33.75/hr
Pend smart sets * Schedule surgeries * Work applicable work queues * Enter/edit outside test ... Messaging (CRM) if applicable * 2nd calls in CRM if applicable * Telephone encounters * My open ...
PRACTICE CRD 2
Berkeley, CA · On-site
$29.50 - $33.75/hr
Pend smart sets * Schedule surgeries * Work applicable work queues * Enter/edit outside test ... Messaging (CRM) if applicable * 2nd calls in CRM if applicable * Telephone encounters * My open ...
NY · On-site
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
NY · On-site
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Helps to provide the nurse manager with concerns regarding employee performance and handles in the ... Acts as house supervisor/main resource on off shifts (nights, weekends, holidays) keeping all units ...
Helps to provide the nurse manager with concerns regarding employee performance and handles in the ... Acts as house supervisor/main resource on off shifts (nights, weekends, holidays) keeping all units ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
... to: CRM messages, telephone encounters, referrals, APeX in-baskets, scanning, filing ... Within six months of start date, based upon completion of training, the Supervisor, completes the ...
New
... to: CRM messages, telephone encounters, referrals, APeX in-baskets, scanning, filing ... Within six months of start date, based upon completion of training, the Supervisor, completes the ...
New
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Work with Auro Medics management team in identifying new contracting opportunities within ... The more time employee's s pend on a function, the more likely it is that the function is essential.
Work with Auro Medics management team in identifying new contracting opportunities within ... The more time employee's s pend on a function, the more likely it is that the function is essential.
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for ... It is within the nurse's discretion to pend requests for additional information and/or request ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for ... It is within the nurse's discretion to pend requests for additional information and/or request ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Coordinate and manage daily huddles. Prepare and manage materials and deliverables. * Review ... Pend tests and procedure orders for physician approval and co-signature. * Prepare prescriptions or ...
Medical Assistant - Fremont, CA
$22.54 - $26.13/hr
Medical Assistant I, under Clinic Operations Management supervision, will perform various ... Pend in-house lab orders and vaccines * Vaccine administrations * Carry out patient rooming ...
Quick apply
Medical Assistant - Fremont, CA
$22.54 - $26.13/hr
Medical Assistant I, under Clinic Operations Management supervision, will perform various ... Pend in-house lab orders and vaccines * Vaccine administrations * Carry out patient rooming ...
Population Healthcare Management RN Case Manager, Ryan White
Sunrise, FL · On-site
$77K - $81K/yr
Complete electronic referrals, medication refills and pend to primary care provider as appropriate ... Employees will be required to perform any other job-related duties assigned by their supervisor or ...
Quick apply
Population Healthcare Management RN Case Manager, Ryan White
Sunrise, FL · On-site
$77K - $81K/yr
Complete electronic referrals, medication refills and pend to primary care provider as appropriate ... Employees will be required to perform any other job-related duties assigned by their supervisor or ...
Medical Assistant - San José, CA
$22.54 - $26.13/hr
Medical Assistant I, under Clinic Operations Management supervision, will perform various ... Pend in-house lab orders and vaccines * Vaccine administrations * Carry out patient rooming ...
Quick apply
Medical Assistant - San José, CA
$22.54 - $26.13/hr
Medical Assistant I, under Clinic Operations Management supervision, will perform various ... Pend in-house lab orders and vaccines * Vaccine administrations * Carry out patient rooming ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for ... It is within the nurse's discretion to pend requests for additional information and/or request ...
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for ... It is within the nurse's discretion to pend requests for additional information and/or request ...
Pend Management Supervisor information
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Clinical Care Reviewer
Harrisburg, PA
Integrated Resources INC
• Recruiting and Staffing Services • 51 - 200 employees51 - 200 employees
Full-time
Re-posted yesterday
Job description
Company Description
Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.
Job Description
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within the nurse's discretion to pend requests for additional information and/or request clarification. The nurse will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases as needed. The nurse will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when guidelines are not met. The nurse will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit's business and uses clinical judgment in their application.
Qualifications
- 3 or more years' experience in a related clinical setting.
- Registered Nurse in Pennsylvania
- Excellent oral and written communication skills.
- Ability to identify problems and recommend solutions.
- Self-directed/Ability to work independently.
- Excellent decision making skills.
- Excellent time management skills, prioritizing work and meeting timelines.
- Ability to advocate for member/member family needs.
- Dedicated to meeting the expectations and requirements of internal and external customers.
- Obtains continuing education required to maintain professional licensure.
- Ability to achieve required performance results on all audits and Inter Rater Reliability (Peer to Peer).
Additional Information
Kind Regards,
Kavita Kumari
Clinical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
DIRECT # - 732-844-8726
About Integrated Resources
Sourced by ZipRecruiter
Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.
Industry
Recruiting and staffing services
Company size
51 - 200 Employees
Headquarters location
Edison, NJ, US
Year founded
1996