Talent.com
Tennessee Licensed Clinical Review Manager
Tennessee Licensed Clinical Review ManagerVirtualVocations • Springfield, Massachusetts, United States
No longer accepting applications
Tennessee Licensed Clinical Review Manager

Tennessee Licensed Clinical Review Manager

VirtualVocations • Springfield, Massachusetts, United States
30+ days ago
Job type
  • Full-time
Job description

A company is looking for a Clinical Review Manager to oversee medical reviews for utilization management.

Key Responsibilities

Initiate referrals for appropriate coordination of care

Assist in comprehensive provider and member appeals, including denial interpretation and retrospective claim reviews

Collaborate with the Medical Director and non-clinical staff as needed

Required Qualifications

Active Registered Nurse (RN) license in Tennessee or a participating state

Minimum of 3 years of clinical experience

Proficiency in Microsoft Office applications

Working knowledge of URAC, NCQA, and CMS accreditations

Ability to work independently and manage multiple projects

Create a job alert for this search

Review Manager • Springfield, Massachusetts, United States

Related jobs
North Carolina Licensed Case Manager, RN

North Carolina Licensed Case Manager, RN

VirtualVocations • Springfield, Massachusetts, United States
Full-time
A company is looking for a Remote Case Manager.Key Responsibilities : Collaborate with a multidisciplinary healthcare team to monitor utilization patterns and facilitate appropriate care delivery ...Show more
Last updated: 30+ days ago • Promoted
Ohio Licensed Field RN Case Manager

Ohio Licensed Field RN Case Manager

VirtualVocations • Springfield, Massachusetts, United States
Full-time
A company is looking for a Field RN Case Manager.Key Responsibilities Manage patient care and coordinate services for assigned cases Conduct assessments and develop care plans based on patient n...Show more
Last updated: 30+ days ago • Promoted
Licensed Utilization Review Clinician

Licensed Utilization Review Clinician

VirtualVocations • Springfield, Massachusetts, United States
Full-time
A company is looking for a Utilization Review Clinician - ABA.Key Responsibilities Evaluates member's care and health status related to Applied Behavioral Analysis (ABA) services Performs prior ...Show more
Last updated: 30+ days ago • Promoted
State Licensed Senior Clinical Appeals RN

State Licensed Senior Clinical Appeals RN

VirtualVocations • Hartford, Connecticut, United States
Full-time
A company is looking for a Senior Clinical Appeals RN.Key Responsibilities Analyze and respond to DRG appeals, including complex conceptual analyses Review medical records and collaborate with a...Show more
Last updated: 3 days ago • Promoted
Arizona Licensed Care Review Clinician

Arizona Licensed Care Review Clinician

VirtualVocations • Springfield, Massachusetts, United States
Full-time
A company is looking for a Care Review Clinician (RN).Key Responsibilities Assess services for members to ensure optimum outcomes and compliance with regulations Analyze clinical service request...Show more
Last updated: 2 days ago • Promoted
Texas Licensed Clinical Nurse Director

Texas Licensed Clinical Nurse Director

VirtualVocations • Springfield, Massachusetts, United States
Full-time
A company is looking for a Director of Utilization Management.Key Responsibilities Develop and implement strategic plans for Utilization Management aligned with organizational goals Direct all U...Show more
Last updated: 4 days ago • Promoted
Travel Nurse RN - Operating Room - $2,429 per week in Willimantic, CT

Travel Nurse RN - Operating Room - $2,429 per week in Willimantic, CT

TravelNurseSource • Hartford, Connecticut, US
Full-time
TravelNurseSource is working with Medical Solutions to find a qualified OR RN in Willimantic, Connecticut, 06226!.A facility in Willimantic, CT is seeking its next amazing RN (Registered Nurse) to ...Show more
Last updated: 7 days ago • Promoted
New Jersey Licensed Case Manager

New Jersey Licensed Case Manager

VirtualVocations • Springfield, Massachusetts, United States
Full-time
A company is looking for an RN II-Case Manager (REMOTE).Key Responsibilities : Assess patients' clinical needs and ensure appropriate levels of care Coordinate and implement care plans for member...Show more
Last updated: 30+ days ago • Promoted
Washington RN Care Review Clinician

Washington RN Care Review Clinician

VirtualVocations • Springfield, Massachusetts, United States
Full-time
A company is looking for a RN Care Review Clinician Critical Care to provide support for clinical member services review assessment processes. Key Responsibilities Assesses services for members to...Show more
Last updated: 14 hours ago • Promoted • New!
Behavioral Health Utilization Review RN

Behavioral Health Utilization Review RN

VirtualVocations • Springfield, Massachusetts, United States
Full-time
A company is looking for a Behavioral Health Utilization Review RN for a full-time remote position.Key Responsibilities Review and evaluate electronic medical records for emergency admissions and...Show more
Last updated: 30+ days ago • Promoted
Travel Nurse RN - Operating Room in Willimantic, CT

Travel Nurse RN - Operating Room in Willimantic, CT

TravelNurseSource • Willimantic, CT, US
Full-time
TravelNurseSource is working with TNAA | TotalMed to find a qualified OR RN in Willimantic, Connecticut, 06226!.Travel Nurse Across America is seeking a qualified Operating room RN needed for trave...Show more
Last updated: 7 days ago • Promoted
Clinical Review Coordinator

Clinical Review Coordinator

VirtualVocations • Hartford, Connecticut, United States
Full-time
A company is looking for a Clinical Review Coordinator to support their Specialty Infusion Pharmacy remotely.Key Responsibilities Conducts prior authorization reviews to evaluate patient clinical...Show more
Last updated: 3 days ago • Promoted
Tennessee Licensed Case Manager Nurse

Tennessee Licensed Case Manager Nurse

VirtualVocations • Hartford, Connecticut, United States
Full-time
A company is looking for a Case Manager Visit Nurse for North MS.Key Responsibilities Provide specialized nursing assessment, care, evaluation, and education to patients and families Promote evi...Show more
Last updated: 3 days ago • Promoted
Remote Inpatient Care Management RN

Remote Inpatient Care Management RN

VirtualVocations • Springfield, Massachusetts, United States
Remote
Full-time
A company is looking for an Inpatient Care Management RN - Remote.Key Responsibilities Perform initial and concurrent review of inpatient cases using evidence-based criteria Collaborate with hea...Show more
Last updated: 3 days ago • Promoted
State Licensed Senior Bill Reviewer

State Licensed Senior Bill Reviewer

VirtualVocations • Hartford, Connecticut, United States
Full-time
A company is looking for a Senior Complex Bill Reviewer.Key Responsibilities Review and analyze medical bills, treatment records, and diagnostic reports related to auto accident injuries Identif...Show more
Last updated: 13 hours ago • Promoted • New!
Arizona Licensed Clinical Systems Director

Arizona Licensed Clinical Systems Director

VirtualVocations • Hartford, Connecticut, United States
Full-time
A company is looking for a Director, Clinical Systems.Key Responsibilities Lead and direct a team supporting clinical systems and oversee the system development lifecycle (SDLC) Manage the creat...Show more
Last updated: 15 hours ago • Promoted • New!
Travel Nurse RN - Outpatient Clinic - $2,054 to $2,277 per week in Boston, MA

Travel Nurse RN - Outpatient Clinic - $2,054 to $2,277 per week in Boston, MA

TravelNurseSource • Springfield, Massachusetts, US
Full-time
TravelNurseSource is working with LRS Healthcare to find a qualified Outpatient Clinic RN in Boston, Massachusetts, 02215!. Ready to start your next travel adventure? LRS Healthcare offers a full be...Show more
Last updated: 7 days ago • Promoted
Travel Nurse RN - Operating Room - $2,299 to $2,446 per week in Willimantic, CT

Travel Nurse RN - Operating Room - $2,299 to $2,446 per week in Willimantic, CT

TravelNurseSource • Willimantic, CT, US
Full-time
TravelNurseSource is working with Fusion Medical Staffing to find a qualified OR RN in Willimantic, Connecticut, 06226!.Facility in Willimantic, Connecticut. Fusion Medical Staffing is seeking a ski...Show more
Last updated: 7 days ago • Promoted
Travel Nurse RN - Outpatient Clinic - $1,734 to $1,922 per week in Nantucket, MA

Travel Nurse RN - Outpatient Clinic - $1,734 to $1,922 per week in Nantucket, MA

TravelNurseSource • Springfield, Massachusetts, US
Full-time
TravelNurseSource is working with LRS Healthcare to find a qualified Outpatient Clinic RN in Nantucket, Massachusetts, 02554!. Ready to start your next travel adventure? LRS Healthcare offers a full...Show more
Last updated: 3 days ago • Promoted
Clinical Study Operations Manager

Clinical Study Operations Manager

VirtualVocations • Hartford, Connecticut, United States
Full-time
A company is looking for a Clinical Study Operations Manager.Key Responsibilities Oversee study startup planning, site onboarding, and operational oversight to ensure timely execution of clinical...Show more
Last updated: 3 days ago • Promoted