Talent.com
LA Licensed Clinical Review Nurse

LA Licensed Clinical Review Nurse

VirtualVocationsAppleton, Wisconsin, United States
1 day ago
Job type
  • Full-time
Job description

A company is looking for a Clinical Review Nurse - Concurrent Review.

Key Responsibilities

Perform concurrent reviews to determine overall health and appropriate level of care for members

Review quality and continuity of care, including acuity level and discharge planning

Collaborate with healthcare providers and Medical Affairs to discuss member care and provide recommendations

Required Qualifications, Training, and Education

Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing

2 - 4 years of related experience, with 2+ years of acute care experience required

Knowledge of Medicare and Medicaid regulations preferred

Knowledge of utilization management processes preferred

LPN - Licensed Practical Nurse - State Licensure required

Create a job alert for this search

Clinical Review Nurse • Appleton, Wisconsin, United States

Related jobs
  • Promoted
  • New!
Hawaii Licensed Review Nurse RN

Hawaii Licensed Review Nurse RN

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Preservice Review Nurse RN - Remote in Hawaii.Key Responsibilities Assess and interpret customer needs and requirements Identify solutions to non-standard requests and...Show moreLast updated: 10 hours ago
  • Promoted
South Carolina Licensed RN Reviewer

South Carolina Licensed RN Reviewer

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for an RN Medical Reviewer II to perform medical reviews and support medical claims processing.Key Responsibilities Conduct medical claim reviews for complex services and det...Show moreLast updated: 2 days ago
  • Promoted
Tennessee Licensed Clinical Review Manager

Tennessee Licensed Clinical Review Manager

VirtualVocationsAppleton, Wisconsin, United States
Full-time
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 co...Show moreLast updated: 30+ days ago
  • Promoted
North Carolina Licensed Clinical Nurse

North Carolina Licensed Clinical Nurse

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a RN Clinical Nurse II - Nurse Connect.Key Responsibilities Participates in patient education and assesses readiness to learn Evaluates patient care outcomes and communi...Show moreLast updated: 30+ days ago
  • Promoted
  • New!
Wisconsin Licensed Clinical Review Nurse

Wisconsin Licensed Clinical Review Nurse

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Clinical Review Nurse - Prior Authorization.Key Responsibilities Analyze prior authorization requests to determine medical necessity and appropriate level of care Coor...Show moreLast updated: 20 hours ago
  • Promoted
  • New!
North Carolina Licensed Clinical Resource Nurse

North Carolina Licensed Clinical Resource Nurse

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a HSPC Clinical Resource Nurse.Key Responsibilities Ensures appropriate clinical pathways are assigned on the plan of care Completes daily oversight of the Muse system f...Show moreLast updated: 16 hours ago
  • Promoted
New York Licensed Clinical Review Nurse

New York Licensed Clinical Review Nurse

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Clinical Review Nurse.Key Responsibilities Perform Utilization Review activities in accordance with jurisdictional guidelines Assess medical necessity and appropriaten...Show moreLast updated: 30+ days ago
  • Promoted
State Licensed Clinical Content Reviewer

State Licensed Clinical Content Reviewer

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Clinical Content Editor - PGY-1 / Medical Students.Key Responsibilities Collaborate with a multidisciplinary team to create and curate content on emerging medical technol...Show moreLast updated: 1 day ago
  • Promoted
Maryland Licensed Clinical Appeals Nurse

Maryland Licensed Clinical Appeals Nurse

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Clinical Appeals Nurse (Remote).Key Responsibilities Investigates and analyzes written appeals and reconsideration requests, responding with detailed letters while adhe...Show moreLast updated: 1 day ago
  • Promoted
Minnesota Licensed Registered Nurse

Minnesota Licensed Registered Nurse

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Registered Nurse for the Weight Management Program.Key Responsibilities Collaborate with an interprofessional team to provide care to patients on GLP-1 medications Edu...Show moreLast updated: 1 day ago
  • Promoted
California Licensed Review Nurse

California Licensed Review Nurse

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Pre-Service Review Nurse RN to work remotely in the Pacific or Mountain Time Zones.Key Responsibilities Conduct utilization management, including Prior Authorization Re...Show moreLast updated: 2 days ago
  • Promoted
Registered Nurse Clinical Content Reviewer

Registered Nurse Clinical Content Reviewer

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Panel Review Subject Matter Expert (SME).Key Responsibilities Collaborate with a multidisciplinary team to create and curate content on emerging medical technologies C...Show moreLast updated: 1 day ago
  • Promoted
  • New!
Utilization Review Clinical Liaison

Utilization Review Clinical Liaison

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Utilization Review Clinical Liaison.Key Responsibilities Serve as the primary point of contact for 1st level utilization review (UR) cases Coordinate 2nd level escalat...Show moreLast updated: 18 hours ago
  • Promoted
  • New!
Texas Licensed Clinical Nurse Director

Texas Licensed Clinical Nurse Director

VirtualVocationsAppleton, Wisconsin, 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 moreLast updated: 14 hours ago
  • Promoted
Oregon Licensed Clinical Nurse Auditor

Oregon Licensed Clinical Nurse Auditor

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Clinical Nurse Auditor, HEDIS who will conduct clinical quality audits and improve quality within the healthcare network. Key Responsibilities Conduct clinical quality a...Show moreLast updated: 2 days ago
  • Promoted
Multistate Licensed Telehealth Nurse

Multistate Licensed Telehealth Nurse

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Registered Nurse / RN in Telehealth Nursing.Key Responsibilities Conduct remote patient assessments, triage, and crisis intervention using telecommunication technologie...Show moreLast updated: 1 day ago
  • Promoted
Tennessee Licensed Senior Medical Reviewer

Tennessee Licensed Senior Medical Reviewer

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Registered Nurse Senior Medical Reviewer (Home Health and Hospice).Key Responsibilities Acts as team leader for medical review and case management, providing guidance a...Show moreLast updated: 6 days ago
  • Promoted
  • New!
Ohio Licensed Utilization Nurse Consultant

Ohio Licensed Utilization Nurse Consultant

VirtualVocationsAppleton, Wisconsin, United States
Full-time
A company is looking for a Utilization Management Nurse Consultant.Key Responsibilities Assess, plan, implement, coordinate, monitor, and evaluate healthcare services / benefits for members Gather...Show moreLast updated: 16 hours ago