1 - 10 of 3,014 Medical Necessity Reviewer jobs

  • RN Patient Admissions Call Center - Flex - All Shifts/Combo of Shifts

    UC Health

    - Loveland, CO

    for clinical/unit appropriateness and medical necessity. Takes action in the event criteria are not met or appropriate resources are not available. Provides direction and support...

    4 days ago from UC Health
  • Utilization Review Nurse (RN)


    The Execu|Search Group

    - New York City, NY

    member and/or family to determine medical necessity and benefit eligibility * ... medical necessity criteria to a physician reviewer for consideration, ensuring the...

    3 days ago from Execu-Search
  • Case Management Assistant, Kindred Hospital Northlake

    Kindred Healthcare

    - Chicago, IL

    reviews to payers for the completion of medical necessity reviews. Monitors, ... and medical necessity for hospitalization. Ability to maintain...

    12 days ago from Kindred Healthcare
  • Medical Necessity Specialist (Manatee county)

    Sunshine State Health Plan

    - Tampa, FL

    quarterly clinical training occurs Attend medical necessity fair hearing Conduct thorough and sound clinical and functional review of member’s needs Ensure compliance with all...

    24 days ago from Centene
  • Medical Review Nurse - Casual Status


    - Nashville, TN

    Review Nurse - Casual Status ( Medical Reviewer ), you will support the Medical ... reviewing medical claims to determine medical necessity and appropriateness *...

    9 days ago from NCI
  • Medical Billing Specialist


    - Mansfield, TX

    Medical Billing/Research Specialist Position Summary : Responsible for reviewing accounts ... for processing Hold Reports to determine necessity of the account hold and correct...

    5 days ago from Intermedix Corp.
  • Registered Nurse ED Utilization Review

    Medical Staffing Network Care Management

    - Brooklyn, NY

    possible reimbursement issues, LOS, and/or medical necessity Job Requirements Please be ... experience and guidelines required How Medical Staffing Network Care Management...

    12 days ago from Medical Staffing Network Care Management
  • Nurse Medical Mgmt I/II- Utilization Management Inpatient Review (Eligible for OPW for Inpatient UM Internals)


    - Tennessee

    effective care through assessing the medical necessity of inpatient admissions, ... Management, Evidence Based Criteria, Medical Necessity Review, McKesson Level I: •...

    9 days ago from Anthem, Inc
  • Clinical Reviewer, LOC/ Level I - Part Time


    - Franklin, TN

    ization reviews for contracted services; screening for diagnosis or suspicion of serious mental illness and or intellectual disability, and medical necessity for short or long...

    6 days ago from Maximus
  • RN - Utilization Mgt/Front End Review for HH - Central Region (KS, MO, AK, OK)



    - Des Peres, MO

    in reviewing actual and proposed medical care and services against established CMS ... Front End Review / Concurrent Review and Medical Necessity Review Manage network participa...

    2 days ago from Humana
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