Talent.com
Tennessee Licensed Clinical Review Manager

Tennessee Licensed Clinical Review Manager

VirtualVocationsFullerton, California, United States
30+ days ago
Job type
  • Full-time
Job description

A company is looking for a Clinical Review Manager to oversee clinical information and ensure appropriate care for members.

Key Responsibilities

Research clinical information from providers using CMS guidelines to ensure members receive necessary services

Initiate referrals and coordinate care while consulting with the Medical Director as needed

Assist with administrative reviews and perform comprehensive appeals and claim reviews

Required Qualifications

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

Minimum of 3 years of clinical experience

Proficiency in Microsoft Office (Outlook, Word, Excel, PowerPoint)

Knowledge of URAC, NCQA, and CMS accreditations

Ability to work independently in a fast-paced environment

Create a job alert for this search

Licensed Clinical Manager • Fullerton, California, United States

Related jobs
  • Promoted
Clinical Review Specialist II (On-Site)

Clinical Review Specialist II (On-Site)

University of California - Los Angeles HealthSanta Monica, CA, United States
Full-time
Play a key role within a world-class health system.Help ensure the delivery of safe, award-winning care and positive patient outcomes. Make the most of your background and abilities.You can do all t...Show moreLast updated: 30+ days ago
  • Promoted
Florida Licensed Clinical Therapist

Florida Licensed Clinical Therapist

VirtualVocationsNorth Hollywood, California, United States
Full-time
A company is looking for a Licensed Clinical Therapist (LCSW / LMHC / LMFT) for an Adult Intensive Outpatient Virtual Group. Key Responsibilities Provide virtual IOP remote group coverage via video co...Show moreLast updated: 30+ days ago
  • Promoted
Tennessee Licensed Clinical Review Manager

Tennessee Licensed Clinical Review Manager

VirtualVocationsVan Nuys, California, United States
Full-time
A company is looking for a Clinical Review Manager to oversee clinical information and ensure appropriate care for members. Key Responsibilities Research clinical information from providers using ...Show moreLast updated: 17 days ago
  • Promoted
  • New!
Tennessee Licensed RN Auditor

Tennessee Licensed RN Auditor

VirtualVocationsCarson, California, United States
Full-time
A company is looking for a Registered Nurse (RN), Auditor.Key Responsibilities Review bills for accuracy compared to medical records Identify and correct ongoing problems through documentation r...Show moreLast updated: 17 hours ago
  • Promoted
Minnesota Licensed Urology Reviewer

Minnesota Licensed Urology Reviewer

VirtualVocationsTorrance, California, United States
Full-time
A company is looking for Board Certified Physician Reviewers specializing in Urology with a Minnesota license.Key Responsibilities Evaluate medical records and provide clinical summaries Engage ...Show moreLast updated: 30+ days ago
  • Promoted
  • New!
Clinical Documentation Integrity Program Manager - Onsite (Torrance)

Clinical Documentation Integrity Program Manager - Onsite (Torrance)

Torrance MemorialTorrance, CA, US
Part-time
Clinical Documentation Improvement Program Manager.This position is onsite at Torrance Memorial Medical Center and is not a remote position. Using advanced knowledge of documentation / regulatory / paye...Show moreLast updated: 5 hours ago
  • Promoted
  • New!
Licensed Clinical Manager

Licensed Clinical Manager

VirtualVocationsBurbank, California, United States
Part-time
A company is looking for a Clinical Manager - Part-Time.Key Responsibilities Report directly to the Director of Therapy and manage a cohort of providers Maintain a clinical caseload and engage i...Show moreLast updated: 21 hours ago
  • Promoted
Texas Licensed Clinical Review Nurse

Texas Licensed Clinical Review Nurse

VirtualVocationsMission Viejo, California, United States
Full-time
A company is looking for a Clinical Review Nurse - Concurrent Review.Key Responsibilities Perform concurrent reviews to assess member health and appropriate level of care Review quality and cont...Show moreLast updated: 30+ days ago
  • Promoted
Psychiatric Technician - Statewide in CA

Psychiatric Technician - Statewide in CA

California Department of Corrections and RehabilitationWrightwood, California, US
Full-time
Psychiatric Technician - Statewide in CA Position : Psychiatric Technician Location : Statewide - Multiple Locations Throughout California Annual Salary Range : $71,460 - $105,084 California Correctio...Show moreLast updated: 30+ days ago
  • Promoted
Clinical Manager, Critical Care Unit

Clinical Manager, Critical Care Unit

Huntington HospitalPasadena, CA, US
Full-time
When you join the Huntington Hospital team, you are aligning yourself with an organization whose values drive our philosophy of compassionate community care. Over the past 129 years, we’ve gro...Show moreLast updated: 2 days ago
  • Promoted
Regional Clinical Service Manager, CAS (Los Angeles)

Regional Clinical Service Manager, CAS (Los Angeles)

Medtronic PlcLos Angeles, CA, US
Full-time
At Medtronic you can begin a life-long career of exploration and innovation, while helping champion healthcare access and equity for all. You'll lead with purpose, breaking down barriers to innovati...Show moreLast updated: 30+ days ago
  • Promoted
Colorado Licensed Clinical Documentation Specialist RN

Colorado Licensed Clinical Documentation Specialist RN

VirtualVocationsCorona, California, United States
Full-time
A company is looking for a Clinical Documentation Specialist RN.Key Responsibilities Conducts concurrent reviews of clinical documentation in medical records to ensure compliance and accuracy for...Show moreLast updated: 2 days ago
  • Promoted
  • New!
Clinical Manager (Los Angeles)

Clinical Manager (Los Angeles)

VyncaLos Angeles, CA, US
Part-time
Join the dynamic journey at Vynca, where we're passionate about transforming care for individuals with complex needs.Were more than just a team. we're a close-knit community.Our shared commitment t...Show moreLast updated: 5 hours ago
  • Promoted
Licensed Mental Health Therapist (LMFT, LCSW, LPCC) - Mt Baldy, CA

Licensed Mental Health Therapist (LMFT, LCSW, LPCC) - Mt Baldy, CA

LifeStance HealthMount Baldy, CA, US
Full-time
At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better. Our mission is to help people lead healthier, more fulfilling lives...Show moreLast updated: 30+ days ago
  • Promoted
  • New!
Tennessee and Missouri RN Clinical Review Coordinator

Tennessee and Missouri RN Clinical Review Coordinator

VirtualVocationsHuntington Beach, California, United States
Full-time
A company is looking for a LOS Clinical Review Coordinator for TN and MO.Key Responsibilities Request and review member's clinical information from providers Perform utilization review of inpati...Show moreLast updated: 11 hours ago
  • Promoted
Maryland Licensed Clinical Appeals RN

Maryland Licensed Clinical Appeals RN

VirtualVocationsSanta Ana, California, United States
Full-time
A company is looking for a Clinical Appeals RN to work on post-service appeals for Medicare-based claims remotely.Key Responsibilities : Review provider post-service appeals for Medicare and Retir...Show moreLast updated: 2 days ago
  • Promoted
  • New!
Texas Licensed Clinical Policy Manager

Texas Licensed Clinical Policy Manager

VirtualVocationsOntario, California, United States
Full-time
A company is looking for a Manager, Vendor Clinical Policy to join their Clinical Policy team.Key Responsibilities Evaluate vendor policy sets to ensure compliance with internal and external medi...Show moreLast updated: 17 hours ago
  • Promoted
  • New!
Georgia Licensed Clinical Policy Manager

Georgia Licensed Clinical Policy Manager

VirtualVocationsNorth Hollywood, California, United States
Full-time
A company is looking for a Manager, Vendor Clinical Policy to join their Clinical Policy team.Key Responsibilities Clinically evaluate vendor policy sets for compliance with medical standards and...Show moreLast updated: 17 hours ago
  • Promoted
  • New!
RN / LVN Regional Clinical Liaison - Los Angeles, CA

RN / LVN Regional Clinical Liaison - Los Angeles, CA

Skilled Wound CareLos Angeles, CA, US
Full-time
These are some of Skilled Wound Care's core values; we are seeking the absolute best people in healthcare to help us change the way that care is delivered. Skilled Wound Care is looking for a.RN...Show moreLast updated: 20 hours ago
  • Promoted
Vendor & Contract Review Manager

Vendor & Contract Review Manager

Northrop Grumman Federal CrediGardena, CA, US
Full-time
Launching your career with Northrop Grumman Federal Credit Union (NGFCU) means being a valued team member at one of the strongest credit unions in the country. AT NGFCU, we understand that our emplo...Show moreLast updated: 30+ days ago